New Antibiotic Prophylaxis Guidelines for Dental Patients from the American Heart Association

Recently, the American Heart Association updated its recommendations regarding dental patients and the necessity of pre-medicating with antibiotics to prevent infective endocarditis (IE) — an infection of the heart's inner lining or the heart valves — before visiting their dentist.

The new guidelines are based on a growing body of scientific evidence that shows the risks of taking precautionary antibiotics outweigh the benefits for most patients. Preventive antibiotics are not only unnecessary for most people but could result in allergic reactions or dangerous antibiotic resistance.

Patients at the greatest danger of bad out- comes from IE and for whom preventive antibiotics are recommended include those with (1) a history of having had IE (2) artificial heart valves (3) a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter interventions, during the first six months after the procedure (4) any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or prosthetic device (5) certain specific, serious congenital (present from birth) heart conditions, including: unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits (6) a cardiac transplant which develops a problem in a heart valve.

The new guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people 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.

Are antibiotics still recommended for patients with artificial joints? The American Dental Association and the American Academy of Orthopaedic Surgeons still recommend that all patients take antibiotics during the first two years after total joint replacement before certain dental procedures, and beyond two years in immunocompromised patients.

If you fall into any of these categories, it is the policy of this office to consult with your physician or cardiologist before making a final determination as to antibiotic therapy. We highly recommend that anyone who has been diagnosed with any of the conditions listed in this article should be seeing their GP's and cardiologist regularly.