If you have a heart condition, you may have heard that in some rare circumstances, antibiotics should be taken before you have a dental procedure. Chances are, however, you won’t have to. Although the guidelines used to be different, the conditions for this preventative measure are now are limited to a very small patient population with rare or uncommon heart disorders. Still, should you be concerned?
The American Heart Association used to recommend that people with a broader range of heart conditions take antibiotics before dental procedures that involve manipulating the gums, lining of the mouth, or the area around the tooth roots. That’s because these procedures carry a very small risk for a condition called endocarditis (IE), which can occur when oral bacteria enters the bloodstream and reaches the heart when the gums or oral tissues are being worked on by a dentist. Again, the chances of contracting IE are usually very small, but it can be life-threatening and is more readily contracted by patients with certain heart conditions. In that light, it has made sense for some patients to take antibiotics before dental procedures to further minimize the risk.
In the past few years, however, the AHA and the American Dental Association (ADA) have done more intensive research into the connection between IE and dental procedures and have found that most patients with heart conditions don’t need antibiotics and, in fact, taking antibiotics can lead to more risks by increasing the amount of drug-resistant bacteria in the body. This means that when the body does have to fight off an infection, the bacteria won’t be affected by the antibiotics and can result in an infection that is difficult or impossible to treat.
According to the AHA and the ADA, conditions that do not necessitate antibiotics before a dental procedure are mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, and most congenital heart conditions. Patients who may require antibiotics are those who have had IE in the past, have had a complications with their heart valves during a heart transplant, have prosthetic heart valves, or have some very specific and serious congenital heart conditions such as palliative shunts and conduits, or have recently undergone a procedure to correct a congenital heart defect that involved using prosthetics. In additional rare occasions, patients who have had complications from joint replacement surgery may need to take preventive antibiotics before dental procedures as well.
If you think your heart condition may necessitate antibiotics before a dental procedure, you should consult with your primary care doctor and your dentist to see if it’s really worth the risk of potentially making your body more resistant to antibiotics in the long term. If you do need preventative antibiotics, you will usually need to take them before the dental procedure to ensure that the antibiotics have reached adequate blood levels by the time the gums are being worked on. However, in some cases, the antibiotics can be taken up to 2 hours after the procedure to effectively prevent IE.