New guidelines for taking antibiotics before dental procedures

Taking a precautionary antibiotic before a trip to the dentist isn’t necessary for most people and, in fact, might do more harm than good, according to updated recommendations from the American Heart Association.

Good news in the new guidelines

The AHA's guidelines were published in its scientific journal, "Circulation", earlier this year and there is good news: the AHA recommends that only people who are at the greatest risk of bad outcomes from infective endocarditis (IE) should receive short-term preventive antibiotics before routine dental procedures. Infective endocarditis is an infection of the heart's inner lining or the heart valves, which results when bacteria enter the bloodstream and travel to the heart.

The guidelines say that many patients who have taken preventive antibiotics regularly in the past no longer need them, including people with the following conditions:

  • 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.

Delta Dental played an important role in the development of these new treatment guidelines by providing data to the AHA on the frequency of dental procedures received by millions of patients over the course of a year.

Risks of preventive antibiotics outweigh the benefits

The revised guidelines are based on a growing body of scientific evidence that shows that the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics and, more significantly, the development of drug-resistant bacteria.

In addition, a comprehensive review of published studies suggests that IE is more likely to occur as a result of everyday activities than from a dental procedure. Scientists found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection, as their hearts already are exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing.

The AHA guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.

Some conditions still warrant preventive antibiotics

There are, however, some patients who should still take antibiotics prior to dental procedures. Patients at the greatest risk of bad outcomes if they developed a heart infection, and for whom preventive antibiotics prior to a dental procedure are worth the risks, include those with the following conditions:

  • Artificial heart valves
  • A history of having had IE
  • Certain specific, serious congenital (present from birth) heart conditions
  • A cardiac transplant which develops a problem in a heart valve.

Patients and their families should ask their primary care doctor or their cardiologist if there is any question at all as to whether they should continue to take preventive antibiotics based on the new guidelines. Patients and their families should ask careful questions of their doctors and dentists anytime antibiotics are suggested before a medical or dental procedure.

They should also be aware that overuse of antibiotics many times can lead to a worse outcome than if they were not used at all. Because of the overuse of antibiotics, there has been a huge increase in the number of bacteria that are now resistant to them. When this happens, new antibiotics must be created to kill these new bacteria. The new bacteria are typically more severe and can cause more serious illnesses.

Overview: New Guidelines from the American Heart Association. American Dental Association. American Heart Association Scientific Statement. American Heart Association.
Last updated: August 2012

The oral health information on this web site is intended for educational purposes only. You should always consult a licensed dentist or other qualified health care professional for any questions concerning your oral health.

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