Message Boards
Today's Active Topics Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Short Commentary: New Heart Association Guidelines for Pre-medication

Fewer Patients Require Antibiotics
Before Dental Procedures


 
“According to the
research, the risks
of taking preventive
antibiotics outweigh
the benefits for
most patients.” 		On April 20, 2007, AnnieB928 started a message board entitled “New American Heart Association Guidelines for Prophylactic Antibiotics,” and posted a press release from the day before that was a joint statement from the AHA and the ADA.

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 the revised guidelines only those patients at greatest risk of IE require prophylactic antibiotics. Included in this list are those with artificial heart valves, 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 infective endocarditis. Those with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, or congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy no longer need antibiotics prior to dental procedures, including extractions and cleanings.

According to the research, the risks of taking preventive antibiotics outweigh the benefits for most patients. Adverse reactions to antibiotics range from mild to potentially severe and, in rare cases, death. Inappropriate or overuse of antibiotics can also lead to the development of drug-resistant bacteria. No compelling evidence was found that antibiotics prevent IE in patients at risk of developing a heart infection. Their hearts are already exposed to bacteria from the mouth through daily brushing and/or flossing and these daily activities are more likely to cause infective endocarditis than a dental procedure.

The guidelines emphasize the value of optimal daily oral health as being more important in reducing the risk of IE than taking preventive antibiotics before a dental visit. Hygienists who previously needed premedication voiced approval of the new guidelines and look forward now to receiving dental hygiene services when an opening in the schedule allows, without waiting an hour for premed.

AnnieB925: I think it’s long overdue. It saved me today when I had a patient show up for a prophy and she had forgotten to take her prophylactic antibiotic. Normally, I would have rescheduled her, but today I was able to tell her that she no longer needs pre-med and we could proceed with treatment. On a side note, my very first employer used to say that patients have more risk of bacteremia from their day-to-day activities, like eating, flossing and brushing. He was right, as was usually the case.

Despite publication of the new guidelines in the scientific journal of the AHA Circulation, many dentists are reluctant to forgo the antibiotics without written consent from the attending cardiologist. Some are finding when phoning or faxing the cardiologists that they have not yet heard about the new guidelines and urge continued premedication. This puts the dentist who has accepted the new guidelines in a tough spot. They want to follow the new guidelines, but also want support from the cardiologist. This is a situation that will take time to implement and must be dealt with on an individual basis.
Sponsors
Site Menu
Message Boards Articles Continuing Education Podcasts Blogs Classifieds News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Hygienetown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450