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Pre medication and the dental office: As a hygienist I must be very aware of the medical history of my patients. One question commonly asked is the need for premedication prior to a dental visit. Prior to April 2007, the American Heart Association’s guidelines were that the following patients must take antibiotics one hour prior to a dental visit, but currently are no longer required: - 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.
The understanding was that if a patient with these conditions took the recommended antibiotics prior to visit it would prevent the increased risk of infectious endocarditis. Infectious endocarditis is when bacteria enters the bloodstream and travels to the heart causing an infection of the inner lining and valves. The American Heart Association posted the new guidelines to premedication in April 2007. They found no evidence that taking the antibiotic premedication made a difference in preventing endocarditis in at risk patients. On a daily basis our bodies are exposed to bacteria possibly entering the bloodstream from tooth brushing , flossing injuries , and open infections. The current guidelines are for those people at the greatest risk of danger. The new guidelines for recommended antibiotic premedication are as follows: - 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.
- 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.
Please contact our office or your medical provider if you have any questions regarding antibiotic premedication prior to your dental visit. It is important to get these questions answered and antibiotics taken if needed PRIOR to appointment because if appropriate guidelines are not followed our office may have to postpone treatment for your safety. Also remember routine dental care at home (tooth brushing twice daily for two minutes, and flossing once daily) is important in reducing infective endocarditis by controlling periodontal disease.Please visit the American Dental Association website for more information:www.ADA.org
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