By Caron Nelson Glickman
Infective endocarditis. Two big words that mean trouble—if it happens to you. Fortunately, the vast majority of people reading this are at very low risk of contracting this infection of the inner-lining of the heart. But dentists have been concerned about this condition and have taken the prevention of it seriously for decades. The reason is two-fold. First, many medical professionals have implicated dental procedures (like cleanings and extractions) as a portal of the bacteria source that causes infective endocarditis (IE)—since there are millions of bacteria in every mouth, and this bacteria can easily make its way into the bloodstream. Second, this condition can be fatal, and when it’s not, it’s almost always quite serious.
So, we ask our patients, “do you have a heart murmur?” and “have you ever had rheumatic fever?” or “do you have an artificial heart valve?”, and if the answer is “yes” to any of these questions, we prescribe antibiotics to prevent IE. It can be a bit of a hassle for both dentist and patient (I’ve had to send people home who didn’t take their medication before their dental cleaning), but certainly worth the risk of developing IE. And then there is the antibiotic regimen recommended by the American Heart Association. In the nearly 20 years that I’ve been in practice, the drug and dosage recommendations have changed 5 times!
Here’s the good news. Last month, the AHA, along with the ADA, updated it’s recommendation for antibiotic prophylaxis (prevention) for IE. They reviewed over 50 years worth of scientific study results and have concluded that only patients who have had IE before or have an artificial heart or artificial heart valve(s), or severe congenital heart defect need to take antibiotics prior to dental treatment. This means that tens of thousands of patients who previously were told to take antibiotics before seeing the dentist may no longer need to. It also means fewer trips to the pharmacy, fewer antibiotic side effects, and less to remember, for patients and dentists. Please check with your physician and dentist regarding these new recommendations.
In a world where it seems that things only get more complicated and restrictions increase every time you turn around, it’s really nice to have a respected medical institution recommend we do less, not more.