November 6, 2010
American Heart Association scientific statement
DALLAS, April 20 – Taking a precautionary antibiotic before a trip to the dentist isn’t necessary for most people, and in fact, might create more harm than good, according to updated recommendations from the American Heart Association.
The guidelines, published in Circulation: Journal of the American Heart Association,are based on a growing body of scientific evidence weighing the effectiveness of antibiotics against possible risks. The updated recommendations say that only people who are at the greatest risk of bad outcomes from infective endocarditis (IE) – an infection of the heart’s inner lining or the heart valves – 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 transplants patients who develop a problem with a heart valve.
For decades, doctors have given short-term antibiotics prior to a dental procedure to many patients with the belief the drugs would prevent IE. As a result, patients with any kind of heart abnormality from mild, symptomless forms of mitral valve prolapse (MVP) to serious congenital birth defects have been instructed to take an antibiotic prior to dental work, even teeth cleaning.
However, the drugs carry risks, including fatal allergic reactions and possibly making the bacteria that cause IE to become resistant to antibiotics. Although allergic reactions are minimal, new evidence shows the risks outweigh the benefits for most patients receiving these antibiotics.
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“We’ve concluded that if giving prophylactic antibiotics prior to a dental procedure works at all – and there’s no evidence that it does work – we should reserve that preventive treatment only for those people who would have the worst outcomes if they get IE. That’s a profound change from previous recommendations,” said Walter R. Wilson, M.D., a professor of medicine at the Mayo Clinic in Rochester, Minn., and chair of the writing group.
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