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Preventive Antibiotics Not Necessary For Most Dental-related Heart Problems

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Antibiotics and Dental-related Heart Problems

Preventive Antibiotics Not Necessary For Most Dental-related Heart Problems

November 26, 2007
By: Beth Walsh for Dental1

Precautionary antibiotics before dental work are not necessary for most people, says the American Heart Association – in a reversal of its longstanding position on the subject. Antibiotics could cause more harm than good for many patients, according to more and more research. This research led the AHA to update its guidelines.
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The American Dental Association recommends the following for good oral hygiene:
  • Brush your teeth twice a day with an ADA-accepted fluoride toothpaste.
  • Replace your toothbrush every three or four months.
  • Floss once a day.
  • Eat a balanced diet and limit between-meal snacks, especially those with a lot of sugar.
  • Visit your dentist regularly for professional cleanings and oral exams.
  • Don’t smoke or chew tobacco.
  • Get enough calcium.

  • Only people at the greatest risk for adverse outcomes from infective endocarditis (IE) should receive short-term preventive antibiotics before common, routine dental procedures. This includes people with artificial heart valves, a history of previous endocarditis, certain serious congenital heart conditions, and heart transplant patients who develop a problem with a heart valve.
    Antibiotics were supposed to prevent IE, but after reviewing the latest scientific evidence, the AHA now recommends preventive antibiotics only for this smaller population.

    IE is an infection of the heart’s inner lining or valves and occurs when bacteria invade the innermost layer of the heart's chambers. Although uncommon, the illness is tough to fight and can be deadly. It also can damage heart valves, lead to heart failure, stroke, or heart rhythm problems, and can make heart tissue prone to other infections.

    The organisms that start endocarditis live in the mouth, so the theory behind the AHA’s recommendation for the past 50 years was to use antibiotics to fight off invading bacteria. These bacteria may result from having a tooth pulled, gum surgery, or other dental work, causing a temporary spike in the number of bacteria in the bloodstream.

    Even so, no large trials have tested whether taking antibiotics before dental work actually prevents endocarditis. If antibiotics do help, the effect is so small that the risk of side effects from the medication outweighs the benefits for most people. Risks include a fatal allergic reaction to the antibiotics and the possibility that IE could become resistant to antibiotics.

    Researchers concluded that maintaining good oral health and hygiene appear to be more protective than prophylactic antibiotics.

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