The AHA's latest guidelines were published
in its scientific journal, Circulation, in April 2007 and there
is good news: the AHA recommends that most of these patients no
longer need short-term antibiotics as a preventive measure before
their dental treatment.
The American Dental Association participated in the development
of the new guidelines and has approved those portions relevant
to dentistry. The Infectious Diseases Society of America and the
Pediatric Infectious Diseases Society endorsed the guidelines.
The guidelines are based on a growing body of scientific evidence
that shows the risks of taking preventive antibiotics outweigh
the benefits for most patients. The risks include adverse reactions
to antibiotics that range from mild to potentially severe cases.
Inappropriate use of antibiotics can also lead to the development
of drug-resistant bacteria.
Scientists also 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. Their hearts already are
often exposed to bacteria from the mouth, which can enter their
bloodstream during basic daily activities such as brushing or
flossing. The new guidelines are based on a comprehensive review
of published studies that suggests IE is more likely to occur
as a result of these everyday activities than from a dental procedure.
The 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.
The new guidelines are aimed at patients who would have the
greatest danger of a bad outcome if they developed a heart infection.
Preventive antibiotics prior to a dental procedure are advised
for patients with:
- artificial heart valves
- a history of infective endocarditis
- 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
- 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 patch
or a prosthetic device
- a cardiac transplant that develops a problem in a heart valve.
The new recommendations apply to many dental procedures, including
teeth cleaning and extractions. Patients with congenital heart
disease can have complicated circumstances. They should check
with their cardiologist if there is any question at all as to
the category that best fits their needs.
Patients and their families should also ask their health care
providers careful questions anytime antibiotics are suggested
before a medical or dental procedure.
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.
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