No antibiotic before teeth cleaning?

Asked by Janet, Leeds
I have a heart murmur and until recently my dentist said I needed antibiotics when I had my teeth cleaned. When did this recommendation change?

Expert Answer
Thanks for your question. Since I do not know the nature of your heart murmur or extent of your dental work, I will provide some general information about antibiotics and dental procedures.

For certain heart conditions, antibiotics are recommended about one hour before invasive medical procedures to prevent a condition called infective endocarditis, which is a potentially life-threatening bacterial infection of the inner lining or valve within the heart.

In 2007 the American Heart Association changed the guidelines so that only people at highest risk for developing infective endocarditis are now advised to receive prophylactic antibiotics before invasive procedures.

The changes were made because it was discovered that infective endocarditis is more likely to occur after frequent exposure to bacteria from routine activities such as chewing food or brushing one's teeth than from occasional dental, gastrointestinal tract or genitourinary tract procedures. In addition, the risks of taking antibiotics were found to exceed the possible benefits to most people. These risks include allergic reactions, diarrhea, bowel infections and the development of bacteria that are highly resistant to available antibiotics.

Antibiotics for the purpose of endocarditis prevention are still recommended for high-risk patients undergoing certain invasive procedures involving the dental area, respiratory tract and infected skin or musculoskeletal tissues. This includes people with conditions such as an artificial heart valve, past history of endocarditis or a heart transplant with abnormal heart valve function. Individuals with certain birth defects of the heart that have not been completely repaired also fall into this higher-risk group.

People who require antibiotics before medical procedures may consider carrying a wallet card as well as making sure the need for such antibiotics is noted in their medical record.

Be sure to consult with your doctor and dentist if you have further questions about your own situation. Good luck!

-  Dr. Jennifer Shu
   Pediatrician,
   Children's Medical Group