Changes in Guidelines for Antibiotic Premedication

The American Heart Association has published new guidelines as of April 2007 regarding the use of preventive antibiotics prior to dental treatment. Previously, patients with certain heart conditions, particularly mitral valve prolapse, were advised to take antibiotics before dental treatment to prevent infective endocarditis (IE).The guidelines recommend that many conditions that routinely called for the use of prophylactic antibiotics in the past no longer benefit from such use. In fact, such unnecessary use of antibiotics can lead to adverse reactions in patients ranging from mild to severe as well as the development of drug-resistant bacteria. Studies suggest that patients with conditions such as mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, and some congenital conditions, are more likely to have infective endocarditis as a result of everyday activities such as brushing and flossing than from a dental procedure. Conditions where preventive antibiotic use is still advised prior to dental treatment include artificial heart valves, a history of infective endocarditis, certain specific congenital heart conditions or a cardiac transplant where problems in a heart valve have developed. Of course, when in question, check with your cardiologist regarding any concerns about the severity of your condition.The American Heart Association emphasizes that the maintenance of optimal oral health and good daily oral hygiene practices are more important in reducing the risk of IE than taking preventive antibiotics prior to dental visits.