New Guidelines: Antibiotic Prophylaxis

Until recently, it was recommended that many patients with cardiac conditions receive short-term antibiotics prior to receiving dental treatment to prevent the risk of infective endocarditis (IE). The American Heart Association (AHA) has since revised those guidelines and the revisions bring good news for most cardiac patients: many patients who have taken prophylactic antibiotics routinely in the past no longer need them.

The American Dental Association (ADA) provided input to the AHA on the new guidelines, which were also developed in part by the Infectious Diseases Society of America and the American Academy of Pediatrics. This group reviewed and analyzed information from both national and international experts on IE and revised guidelines were released last April.

The updated guidelines state that patients who have taken prophylactic antibiotics 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

These revisions are based on scientific evidence that conclude that the risks of taking preventive antibiotics, such as adverse reactions to the antibiotics and development of drug resistant bacteria, outweigh the benefits for most patients.

However, as with any guidelines, there are exceptions. Preventive antibiotics prior to dental procedures are still advised for patients with:

-- Artificial heart valves

-- History of IE

-- Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits

-- A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure or any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

-- Any cardiac transplant that develops a problem in a heart valve

The Pennsylvania Dental Association (PDA) stresses the importance of maintaining good oral hygiene habits as an essential and easy way to prevent IE, and offers the following tips:

-- Brush your teeth twice a day with an ADA-accepted fluoride toothpaste. Replace your toothbrush as soon as the bristles become frayed, about every three to four months. Floss daily to remove plaque stuck between the teeth.

-- Eat a well-balanced diet, limiting sugary snacks and beverages.

-- See your dentist regularly for cleanings and oral exams.

For more information on other oral health topics, visit PDA's website at http://www.padental.org.

Pennsylvania Dental Association
http://www.padental.org