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To Prevent Infective
Endocarditis
New Regulations As
Of April 2007
The mouth is a reflection
of a patient's overall health, medications, harmful habits and nutritional
status.
The oral cavity is
a portal of entry as well as the site of disease for microbial infections that
affect general health.
Streptococcus viridan is
the main infective agent that can enter the bloodstream from areas with
considerable bleeding such as the oral cavity, urinary tract and
gastrointestinal tract.
This bacteria may lodge on the heart valves,
inflame the myocardium and cause ulcerations on the inner walls of the an
artery. Patients with artificial joints, structural heart defect, prosthesis or
pervious severe infections are at a higher risk. These risks are from an
implied association between dental treatments and endocarditis. Yet oral
streptococci still account for one third of all cases of endocarditis.
For decades, the
American Heart Association
(AHA) recommended that patients with
certain heart conditions take
antibiotics shortly before dental
treatment. This was done with the belief
that antibiotics would prevent infective
endocarditis (IE), previously referred
to as bacterial endocarditis. The AHA’s
latest guidelines were published in its
scientific journal, Circulation,
in April 2007 and there is good
news:
the AHA recommends
that most of these patients no longer
need short-term antibiotics as a
preventive measure before their dental
treatment.
The guidelines are based
on a growing body of scientific evidence
that shows the risks of taking
preventive antibiotics outweigh the
benefits for most patients. The risks
include adverse reactions to antibiotics
that range from mild to potentially
severe and, in very rare cases, death.
Inappropriate use of antibiotics can
also lead to the development of
drug-resistant bacteria.
Scientists also found
no compelling evidence that taking
antibiotics prior to a dental procedure
prevents IE in patients who are at risk
of developing a heart infection.
Their hearts are already often exposed
to bacteria from the mouth, which can
enter their bloodstream during basic
daily activities such as brushing or
flossing. The new guidelines are
based on a comprehensive review of
published studies that suggests IE is
more likely to occur as a result of
these everyday activities than from a
dental procedure.
The guidelines say
patients who
have taken prophylactic antibiotics
routinely in the past but no longer
need them include people
with:
 | mitral valve
prolapse |
| rheumatic
heart disease |
| bicuspid valve
disease |
| calcified
aortic stenosis |
| congenital
heart conditions such as ventricular
septal defect, atrial septal defect
and hypertrophic cardiomyopathy.
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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:
- artificial
heart valves
- a history of
infective endocarditis
- certain specific,
serious congenital (present from
birth) heart conditions, including
 | unrepaired
or incompletely repaired
cyanotic congenital heart
disease, including those with
palliative shunts and conduits
|
| a
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
|
| any
repaired congenital heart defect
with residual defect at the site
or adjacent to the site of a
prosthetic patch or a prosthetic
device |
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.
The full report is
available to download below, along with
supporting charts.
If you have any questions about these
guidelines, please feel free to contact
the ADA Division of Science via
e-mail
or by calling 312-440-2878. ADA members
may use the Association’s toll-free
number and ask for x2878.
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Infective
Endocarditis Guidelines
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PDF file/148k
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Legal sidebar
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PDF file/18k
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Table 1:
Summary of 9 Iterations of AHA
Recommended Antibiotic Regimens
from 1955 to 1997 for
Dental/Respiratory Tract
Procedures* |
PDF file/53k
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Table 2:
Primary Reasons for Revision of
the IE Prophylaxis
Guidelines |
PDF file/58k
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Table 3:
Cardiac Conditions Associated
with the Highest Risk of Adverse
Outcome from Endocarditis for
Which Prophylaxis with Dental
Procedures Is Recommended |
PDF file/61k
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Table 4:
Dental Procedures for which
Endocarditis Prophylaxis is
Recommended for Patients in
Table 3 |
PDF file/50k
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Table 5:
Regimens for a Dental Procedure
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PDF file/52k
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Table 6:
Summary of Major Changes in
Updated Document |
PDF file/77k
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Return to Top
American Dental
Association 4/07
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Learn more about premedication and artificial
joints.
Learn more about premedication and heart
conditions.
Breast implants:
http://www.ada.org/public/topics/health_oral_faq.asp
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