The Risks of Taking Antibiotics Prior to Dental Treatment
Outweigh Benefits for Many Heart Patients
By Ron Duffin, DDS

Most likely, if you have a heart murmur, you have been prescribed antibiotics prior to receiving any dental treatment.  This practice was recommended in the past by American Heart Association (AHA) guidelines. 

However, based on AHA’s recently revised guidelines, chances are you will no longer be pre-medicated.  It has been determined that for many patients, the risks associated with taking antibiotics are greater than the benefits.  Therefore, under AHA’s current guidelines, substantially fewer patients are candidates for antibiotic pre-medication.

The idea underlying pre-medication is to avoid oral bacteria (700 species of bacteria could be living in your mouth!) from invading the bloodstream and settling in the heart, where certain bacteria can cause an uncommon, but life-threatening infection called infective endocarditis or IE. 

Administering antibiotics prior to dental procedures has been a widely-used practice for patients with heart valve issues; however, the AHA has determined its effectiveness in preventing IE is not adequately supported.  A more effective means of preventing IE is maintaining good oral hygiene and prevention of dental disease.  This is due to the fact that oral bacteria invades the blood abundantly more from routine daily activities, such as chewing food, tooth brushing, flossing, use of toothpicks and water irrigation devices.

Thus, under the new guidelines, patients who have been historically prescribed antibiotics prior to dental treatment, but who are no longer recommended to be pre-medicated by the American Heart Association, (unless these conditions are present in a patient with a compromised immune system - i.e. diabetes) are those with:  (i) mitral valve prolapse; (ii) rheumatic heart disease; (iii) bicuspid valve disease; (iv) calcified aortic stenosis; (v) certain congenital heart conditions, such as ventricular septal defect, atrial septal defect, hypertrophic cardiomyopathy.  Please consult with your dentist and physician to confirm your needs. 

Preventive antibiotics remain advisable for those patients with:  (i) artificial heart valves; (ii) cardiac transplant with a heart valve problem; (iii) a history of IE; and (iv) certain specific congenital heart conditions (such as unrepaired cyanotic congenital heart disease), repaired congenital heart disease with residual defects, completely repaired congenital heart defect within six months of surgery or catheter intervention. 

For these patients, antibiotics should be administered 30-60 minutes prior to most dental treatment, including teeth cleaning, extractions, suture removal, biopsies and orthodontic bands placement.  Pre-medication typically is not necessary for x-rays, placement/adjustment of removable orthodontic appliances or brackets.  Patients with total joint replacements remain candidates for pre-medication, as well as for one year following surgery, unless otherwise directed by your orthopedist.

Your cardiologist or medical doctor should determine if you are required to have preventive antibiotics prior to your dental treatment.  Additionally, a dentist may refuse to treat a patient who does not consent to the dentist’s recommendation of receiving or not receiving antibiotics.  If you would like more information, please visit www.americanheart.org.