Antibiotics: Your Heart, Joints and Dental Procedures I - Dr. Charles Bell

This is a topic that has caused a significant amount of confusion over the years, partly because of some misconceptions and partly because of some major changes to the guidelines over time.

Before some dental treatments, patients who have certain heart conditions and those with artificial joints need to take antibiotics. This is called antibiotic prophylaxis. These people may be at risk of developing an infection in the heart or the joint site. The presence of antibiotics in the system reduces this risk.

Heart Conditions:

When treating patients with heart issues, dentists follow guidelines that were developed by the American Heart Association in conjunction with the ADA. The AHA recommendations are created to reduce the risk of infective endocarditis. This (IE) is and infection of the lining inside the heart or in the valves.

In the past there were a significant number of heart issues that were deemed appropriate for antibiotic prophylaxis. The length of the prescription was also fairly involved.  However, over time the AHA updates the recommendations given the current research and scientific articles available. As a result fewer patients need to premedicate before dental treatment and the amount of antibiotics has decreased dramatically.

The AHA concluded that:

• The risks of adverse reactions to antibiotics outweigh the benefits of prophylaxis for most patients. Adverse reactions range from skin rash to severe breathing problems.

• Bacteria from the mouth can enter the bloodstream during dental procedures (cleanings, extractions, surgery). Once in the bloodstream it can travel to the heart.

• Bacteria that cause infections can become resistant to antibiotics if drugs are used to often. So doctors try to limit the use of these drugs.