Antibiotic Pre-Medication For Heart Conditions - Updated Standard

Good news for many of our patients who have been taking 4 large pills before their dental treatment. Some of you might not have to take them anymore. One of our patients let out a big hooray, another patient was very worried she/he would develop an infection in their heart. 

We have added a couple of links in our "Links" page to the American Dental Association web site directly to the articles with more detailed information to better help understand the updated standard. We thought we would give a brief summary of the highlights and recommendations. It is important to remember the recommendations still should come from your physician, who knows you and your health requirements the best. We work as a team with your primary care physician or your cardiologist.

As some of you are aware, the American Heart Association has for quite some time recommended pre-medicating patients with certain heart conditions shortly before their dental treatment. The thinking was to prevent a problem called "infective endocarditis" or IE. Infectious endocarditis is, most often, caused by a normal bacteria found in the mouth, as well as on the skin, intestinal and urinary tracts, called Streptococcus Viridan. Infectious endocarditis rarely occurs in people who have healthy heart. When IE does occur, it can infect the heart's inner lining or the heart valves in certain people.

The American Dental Association worked with the American Heart Association to update the guidelines based on several different scientific studies and concerns. These guidelines have also been accepted by the Infectious Disease Society of America and the Pediatric Infectious Diseases Society.

What has become more and more of a concern is the overuse of antibiotics. Taking antibiotics unnecessarily is developing into a growing problem. More and more bacteria are becoming resistant to antibiotics, thus limiting our ability to help fight infections when antibiotics are needed.

What was discovered, is that there was no direct evidence to show that taking antibiotics before dental treatment prevented IE in patients who are at risk for developing this heart infection. These patients are exposed everyday to the bacteria in their mouth from routine activities as normal brushing and flossing. The new guidelines were developed reviewing the published studies to limit both overuse and unnecessary antibiotic treatment.

Who No Longer Requires Antibiotic Prophyaxis Or Pre-Medication:

Patients who previously were pre-medicated before dental treatment due to 

  • Routine hygiene

  • Bleaching

  • Fillings

The updated guidelines are focusing on patients who are at the greatest risk of both developing IE and serious life threatening problems. 

The updated recommendations apply to a few dental treatments, including cleaning and tooth extractions. As always, it is important to check with your own primary care physician and/or your cardiologist to receive specific recommendations for your individual condition and requirements. 

We will follow your specific requirements and recommendations to keep you healthy.

Who Is Advised To Take Antibiotic Prophylaxis And Pre-Medicate Before Dental Treatment:

Patients who are advised to pre-medicate before dental treatment due to: 

  • artificial heart valves

  • a history of infective endocarditis

  • cardiac transplant that develops a problem in a heart valve.

  • certain specific, serious congenital (born with) heart conditions which include

    • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduit
    • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
    • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic device