Antibiotics Before Dental Treatment- Are They Still Needed?
Historically, patients requiring certain types of dental treatment were required to take antibiotics prior to dental care in order to prevent a heart infection caused by certain bacteria that were prevalent in the mouth.
Recently, after reviewing studies about infectious endocarditis, the American Heart Association has suggested a change in the need for antibiotics prior to dental treatment.
The December 2008 issue of The Johns Hopkins Medical Letter addresses the new suggestions for antibiotic prophylaxis and reviews the reasons given for the new thinking.
Previously it was thought that procedures such as routine dental cleanings introduced beta hemolytic streptococci into the blood stream where the bacteria could grow on heart valves of patients who had abnormal blood flow through the heart valves (heart murmur). In order to prevent a serious heart infection, The American Heart Association and the American Dental Association suggested that these patients be pre-medicated with antibiotics prior to receiving certain types of dental treatment.
As reported in the Johns Hopkins Medical Letter, the American Heart Association(AHA) recently reviewed infectious endocarditis (IE) studies between 1950 and 2006 and concluded that only patients at high risk for serious complications from IE should continue taking preventive antibiotics. High risk patients included those who had previous episodes of IE, those with artificial heart valve replacements and repairs, or who had valve problems after a heart transplant, and those patients who had congenital heart defects. Patients with heart murmurs were no longer considered high risk. The AHA panel found little incidence that preventive antibiotics stop IE from developing or that dental procedures cause IE. They concluded that, in fact, millions of IE causing bacteria enter the bloodstream every day as a result of common activities like brushing, flossing and chewing. Yet IE remains rare.
One study of 299 healthy adults found that 33% of blood samples from patients who took antibiotics before dental treatment tested positive for IE causing bacteria after their procedure. Another study evaluated the death rate of high risk patient with artificial heart valves who did not premedicate and found the chance of developing IE was very low, one in 54,000.
The new regime of limiting antibiotics before dental treatment to only high risk individuals will decrease the incidence of allergic reactions to the antibiotics, help prevent antibiotic resistance, reduce the number of medications some patients have to take and will save patients money.
For most people, proper brushing and flossing will go a long way to controlling the bacteria in the mouth.
Tags: AHA, American Heart Association, antibiotics, endocarditis, heart murmur, premedicate