No More Antibiotics

Those of you who have been taking antibiotics for dental procedures may inform your dentists that antibiotics are now only rarely indicated to prevent heart infections. The American Heart Association (AHA) has published new guidelines for the use of antibiotics for dental procedures. Patients with mitral valve prolapse and insufficiency, the largest group of patients previously targeted for antibiotic therapy before tooth cleaning or extraction, are now spared that therapy.

It appears that the risk of cardiac valve infection is much greater from brushing your teeth at home than from going to the dentist for professional cleaning. Three brushings at home release bacteria into the blood stream as frequently as one professional dental cleaning or tooth extraction. Since we brush our teeth every day, and only visit the dentist a couple times a year, the cumulative risk of brushing at home predominates.

Accordingly, it is recommended that only the following individuals receive antibiotics before dental procedures:

1. Those with a prior history of heart infection
2. Those with prosthetic cardiac valves
3. Those with congenital heart disease
4. Cardiac transplant recipients with valvular disease

Over the years I have written antibiotic prescriptions hundreds of times for patients going for dental procedures. Many of them developed diarrhea or yeast infections from those antibiotics.

It is likely that many dentists will not be aware of this new recommendation, and will continue to require patients with heart murmurs or mitral prolapse to take antibiotics.

If you have been subject to this requirement in the past, you may want to carry a copy of the article from Circulation, published online Apr 19, 2007: Prevention of Infective Endocarditis, Guidelines.

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