For decades, the American Heart Association recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief antibiotics would prevent infective endocarditis, previously referred to as bacterial endocarditis.
The latest AHA guidelines were published in the October 2007 edition of its scientific journal Circulation and states that “for most people, the risks of taking prophylaxis antibiotics for certain procedures outweigh the benefits. These guidelines represent a major change in philosophy.”
AHA guidelines now state most people do not need preventive antibiotics. Contrary to past belief, taking unnecessary antibiotics could cause more harm than good by creating allergic reactions and antibiotic resistance. Only patients with a high risk of negative outcomes from infective endocarditis should receive this type of short-term preventive antibiotic prior to dental treatments.
Patients considered high risk for negative outcomes who should still take preventive antibiotics prior to dental procedures are those with:
- Artificial heart valves
- A history of infective endocarditis
- Certain specific, serious congenital heart conditions
- A cardiac transplant that develops a problem in a heart valve.
The American Dental Association was active in the development of the new antibiotic guidelines and approved portions relating to dentistry. Patients that were previously required to take prophylactic antibiotics in the past but no longer need them are those with:
- Mitral valve prolapse
- Rheumatic heart disease
- Bicuspid valve disease
- Calcified aortic stenosis
- Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy
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Since there is little data on dental procedures and prosthetics, the American Academy of Orthopaedic Surgeons has provided recommendations to use as a guideline.
Artificial joints increase the risk of contracting blood-borne infections, so it is advised patients receive preventive treatment prior to any dental procedures that involve high levels of bacteria.
The dentist and orthopaedic surgeon must work together to determine what course of treatment would be appropriate for each individual patient.
The AAOS recommends taking preventive antibiotics prior to dental treatment for patients who have the increased risk of Hematogenous Total Joint Infection and/or have one or more of the following risk factors:
- All patients with prosthetic joint replacement and/or previous prosthetic joint infections
- Inflammatory type of arthritis, such as rheumatoid arthritis or systematic lupus erythematosis
- A weakened immune system resulting from disease, drugs or radiation
- Insulin-dependent (Type 1) diabetes
- Patients with co-morbidities (i.e., diabetes, obesity, HIV, smoking)
- Undernourishment or malnourishment
Health factors are important considerations when receiving dental treatment. Patients should be sure to update their medical histories on file with their dentist. Dentists must exercise their professional judgment in applying these guidelines listed and are not obligated to provide any dental treatment they deem as not being in the patient’s best interest.
For more detailed information, visit the American Academy of Orthodpedic Surgeons website.