Antibiotics and dental work

The American Heart Association has come out with new guidelines regarding the need for antibiotics and dental procedures to protect heart valves. They are based on clinical opinion (experts) but there is very little clinical evidence to show that antibiotics really do help. Are you surprised?
To be sure, the efficacy of antibiotics and the cost effectiveness of the antibiotics have never been proven. In only 4-7.5 % of cases, can we even site sequential relationships between the dental procedure and valve infections.
The infection that we are trying to prevent is called infective endocarditis. It is an infection on the heart valve that can be life threatening. There are about 10-20 thousand new cases of infective endocarditis every year and the mortality is 20-30%, making it a very serious infection.
In order for there to be an infection, the valve must have been the “victim” of an injury. Then, following the injury, bacteria must come along (from the blood) to seed the area.
Bacteria in the blood (bacteremia) is quite common. We “throw” bacteria into the blood when we do something as simple as brushing our teeth. It is thought to be more common when we have dental work. We are not sure how much bacteremia is necessary (how many bacteria need to be exposed to the damaged valve) in order to seed the valve and set the stage for the infection to propagate.

Here are the current recommendations (as of 2007).
Patients to consider for antibiotics should include:
1) A patient with a prosthetic valve (a valve replacement)
2) A patient with a previous history of endocarditis
3) Patients with specific congenital heart disease (ask me the specifics)
4) A patient who is has had a valvulopathy after cardiac transplantation.

The following are the recommendations for use:
1) Amoxicillin 2 grams in adults taken orally
2) Allergy to Penicillin - Clindamycin 600 mg or Azithromycin 50 mg also taken orally

If a patient cannot take oral medication, there are intramuscular or intravenous substitutes.
The bottom line here is those patients with a murmur DO NOT NEED any antibiotic. This is fabulous news but will undoubtedly stir the pot and many of the local dentists will have a tizzy. Have them call me. Those patients belonging to Choice Care can save themselves tons of trouble and time by just referring your dentist to our website or to my phone or email. As usual, we are happy to oblige.