Certain heart conditions
are more often associated with endocarditis than others.
New guidelines for prevention of infective endocarditis were
released by the American Heart Association April 19. The AHA and
ADA now recommend that fewer dental patients with heart disease
receive antibiotic prophylaxis before dental procedures to
prevent the heart infection called infective endocarditis (IE).
The guidelines were developed by a group appointed by the AHA
that included experts in infectious disease and cardiology and
members representing the ADA. The guidelines were endorsed by
the Infectious Diseases Society of America and the Pediatric
Infectious Diseases Society.
After reviewing relevant scientific literature from 1950-2006,
the group concluded that bacteremia resulting from daily
activities is much more likely to cause IE than bacteremia
associated with a dental procedure. In addition, only an
extremely small number of IE cases might be prevented by
antibiotic prophylaxis, even if prophylaxis is 100% effective.
Based on these conclusions, antibiotic prophylaxis is now
recommended before dental procedures only for patients with
underlying cardiac conditions associated with the highest risk
of adverse outcome from IE, such as patients with artificial
heart valves, a history of endocarditis, certain serious
congenital heart conditions and heart transplant patients who
develop a problem with a heart valve.
For more details see
To determined if
an existing heart condition poses a risk you will be asked to complete
health information. You will need to tell us if you have had:
Heart surgery within the past six
Artificial heart valve
Mitral valve prolaspe
Previous bacterial endocarditis
Congenital heart defect
Acquired valvular dysfunction
Within six months of vascular surgery
The elderly are at higher
risk. More than one half of the current cases of endocarditis occur in
people 60 years of age and older with a mortality rate for this group as high as
Poor oral hygiene and
periodontal (gum disease) or periapical infections increase your risk for
The American Hearth
Association recommends antibacterial prophylaxis for at-risk individuals with
any dental procedure that may cause bleeding such as the following procedures:
The current regimen is:
grams of amoxicillin, one hour prior to treatment with no follow-up dosage
Clindamycin, cephalexin, cefadroxil, azithronycin or
clarithromycin as also suggested alternative
If you are allergic to
Amoxicillin AND Clindamycin
Azithromycin or Clarithromycin 500mg 1 hour prior
At our office we also reduce bacteremias by using an antiseptic
mouthrinse for 30 seconds before any procedures are done.
The most effective reduction in bacteria in your mouth is accomplished by
you. It is urgent that you improve your oral
hygiene care in order to improve you oral health by:
Rinsing your mouth with an antiseptic
mouthrinse like BreathRx or Perioguard
to reduce the bacteria count in your mouth BEFORE you do the
Use a Waterpik irriagator on a daily basis.
at least twice a day for 2 minutes or more using a Sonicare
Flossing daily or
using an automatic flosser.
All these will
"stir up" the bacteria in your mouth, yet by using a consistent and
regular self care maintenance routine along with frequent check-ups and
professional cleanings will result in an overall reduction of oral bacteria to
improve not only your oral health but your total well-being.
Antibiotics and You Heart ADA.org
dental procedures can be found on the American Heart Association's website: www.americanheart.org.
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