Pre-medication

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Are you one of the many that is forced to take a large dose of antibiotics before visit-ing the dentist? For decades, the American Heart Association (AHA) has recommend-ed pre-medication for patients with certain heart conditions before most dental proce-dures. The antibiotic regimen was believed to prevent a rare, but life-threatening infec-tion called infective endocarditis (IE). Infective endocarditis is an infection of the heart's inner lining or valves, which results from bacteria entering the bloodstream and traveling to the heart.

Recently the AHA has revised their pre-medication guidelines. Based on a review of new and existing scientific evidence, most dental patients with heart disease do not need antibiotics before dental procedures. This new evidence shows the risks of taking preventive antibiotics outweigh the benefits for most patients. These risks include adverse reactions to antibiotics that range from mild to severe, and in rare cases death. The inappropriate use of antibiotics has also been linked to the development of drug-resistant bacteria.

Scientists also found no compelling evidence that taking antibiotics prior to dental procedures prevents infective endocarditis in patients who are at risk of developing a heart infection. Their hearts are already exposed to the bacteria that resides in the mouth, which can enter the bloodstream during daily activities such as brushing, floss-ing, and even chewing. IE is more likely to occur as a result of these everyday activities than from a dental procedure.

So for the many patients with mild heart conditions such as a heart murmur or mitral valve prolapse, antibiotics are no longer recommended before a dental procedure. Pre-medication is however still recommended for certain cardiac conditions and all heart patients should consult with their physician regarding their risk of infective endocarditis. The new guidelines emphasize that maintaining optimal oral health and practicing good oral hygiene is the most effective method of preventing a heart infection.

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