Dental Procedures & Antibiotic Premedication

10/16/08
By: Dr Larry J Cook

Over the last 30 years the regimen for protecting individuals with certain histories of medical conditions prior to receiving invasive medical/dental procedures has changed dramatically. For all these years, dentists have provided antibiotics for patients with cardiac challenges to prevent bacterial endocarditis, a possible infection of the heart. The subject has been clouded with views that conflict based on scientific evidence, observation, expert opinion, patient fears when giving these prophylactic antibiotics. Over the years the American Heart Association (AHA) has changed the recommendations for prophylactic antibiotic coverage that is proposed for people with certain heart conditions. The AHA has also revised the spectrum of who should be considered for coverage of antibiotics. Over the last 30 years the most common and recommended covered people were those with a history of heart and/or lung devices , prosthetic joints, nonvascular shunts, organ transplants, bone marrow transplants, vascular grafts and shunts, non-dental implants, head & neck radiation therapy, sickle cell anemia, rheumatic heart disease, mitral value prolapse, and immune system suppression.
Most recently, the American Heart Association after years of research has dramatically changed their recommendations for prophylactic antibiotic therapy prior to dental procedures. The evidence supporting the premedication is scanty at best and the risk posed by the antibiotics may outweigh their potential value. Antibiotic use is still recommended for a few conditions, but the research evidence indicates we have been over treating with prophylactic antibiotics. Currently the AHA and the America Dental Association (ADA) no longer recommend preventive antibiotics for dental patients with: mitral value prolapse, rheumatic heart disease, bicuspid value disease, calcified aortic stenosis and for most congenital heart conditions.
The AHA and the ADA still recommended prophylactic antibiotics are still recommended for: artificial heart values, a history of infective endocarditis, certain specific serious congenital heart conditions and persons with a cardiac transplant that develops a problem in a heart valves. As you can see the view on coverage has been radically altered. Since confusion and disagreement among medical and dental practioners could be present, everyone is urged to consult with all of your health providers for a consensus as to your specific needs. Your dental professional will work closely with your physician to determine the most appropriate therapy for you.