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                                                        DR. DAN PETERSON

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Certain heart conditions need to be premedicated BEFORE dental work can be done

     Certain heart conditions are more often associated with endocarditis than others.

Infective Endocarditis

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

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:
bulletmitral valve prolapse
bulletrheumatic heart disease
bulletbicuspid valve disease
bulletcalcified aortic stenosis
bulletcongenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

The new guidelines are aimed at patients who would have the greatest danger of a bad outcome if they developed a heart infection.

Preventive antibiotics prior to a dental procedure are advised for patients with:

  1. artificial heart valves
  2. a history of infective endocarditis
  3. certain specific, serious congenital (present from birth) heart conditions, including
    bulletunrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
    bulleta completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
    bulletany repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
  4. a cardiac transplant that develops a problem in a heart valve.

The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs. ADA 5/07

     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 months


Artificial heart valve


Rheumatic fever




Mitral valve prolaspe


Previous bacterial endocarditis


Pulmonary shunt


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 70%.

     Poor oral hygiene and periodontal (gum disease) or periapical infections increase your risk for endocarditis.

The American Hearth Association recommends antibacterial prophylaxis for at-risk individuals with any dental procedure that may cause bleeding such as the following procedures:


Tooth extractions


Periodontal surgery


Scaling and root planing




Recall maintenance


Dental implant placement


Replantation of avulsed teeth


Subgingival placement of antibiotic fiber or strips


Initial placement of orthodontic bands (not brackets)


Intraligamentary local anesthetic injections


Cleaning of teeth or implants where bleeding is anticipated


Endodontic surgery


Instrumentation beyond the apex

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    The current regimen is:

Two grams of amoxicillin, one hour prior to treatment with no follow-up dosage required. 


Clindamycin, cephalexin, cefadroxil, azithronycin or clarithromycin as also suggested alternative

If you are allergic to Amoxicillin AND Clindamycin use Azithromycin or Clarithromycin 500mg 1 hour prior to procedure.

     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 following:

  1. Use a Waterpik irriagator on a daily basis.

  2. Brushing at least twice a day for 2 minutes or more using a Sonicare toothbrush.

  3. 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


The dental procedures can be found on the American Heart Association's website:
AHA Prophylaxis Guidelines For Prevention Of Bacterial Endocardiditis

Source: American Dental Association 

Resource: American Heart Association-Prevention of Bacterial Endocarditis and ADA Bacterial Endocarditis.


New Recommendations from ADA 5/07

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PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
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