Guidelines Revised for Dental Treatment of Heart Disease Patients

ALBANY, NY (04/23/2007)(readMedia)-- The American Dental Association has announced that, based on a review of new and existing scientific evidence, most dental patients with heart disease do not need antibiotics before dental procedures to prevent infective endocarditis (IE), a rare, but life-threatening heart infection.

According to revised guidelines from the American Heart Association (AHA), with participation from the American Dental Association (ADA), antibiotics are now only recommended for patients at greatest risk of negative outcomes from IE. These include patients with artificial heart valves or certain congenital heart conditions, heart transplant recipients who develop cardiac valve problems, recipients of an artificial patch to repair a congenital heart defect within the past six months and patients with a history of IE.

The AHA's latest guidelines were published in its scientific journal, Circulation, in April. The guidelines apply to a range of medical and dental procedures and those relevant to dentistry will be published online at www.ada.org/goto/endocarditis and in the June issue of the Journal of the American Dental Association (JADA).

For decades, the AHA recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent IE, previously referred to as bacterial endocarditis. IE is an infection of the heart's inner lining or valves, which results when bacteria enter the bloodstream and travel to the heart. Bacteria are normally found in various sites of the body including on the skin and in the mouth.

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.

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 and are encouraged to check with their cardiologist with questions about the category that best fits their needs.

For patients: www.ada.org/public/topics/antibiotics.asp

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