dontlikeliver
Frequent Contributor (1K+ posts)
Member # 4749
posted
Please tell me if you have a similar problem/worry:
I have been told on various occasions over the years 'you have a heart murmur - nothing to worry about'. On doctor did say 'you might want to take abx as a precaution before dental work'.
I do not have a condition that has been detected on any electrocardiogram or regular exam. Just this murmur that nobody seems very concerned about.
Maybe because in the last couple of years I have a lot more palpitations and skips, I am feeling unsure about whether it's OK to have dental work without abx first.
Does anyone else here have a 'harmless' murmur but been told to take abx before dental work? Am I simply worried about nothing?
We think I am also allergic to Penicillin now, and wonder/think that is the abx mostly used for dental stuff (??)
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breathwork
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Yes, it's called mitral valve prolapse. The mitral valve can prolapse a bit causing what is heard as a murmur for several reasons. This valve is between the left atrium and ventrical in the heart.
Knowing the reason is the most helpful bit of information that you can get.
If it's congenital, from birth, and there is no leakage back into the atrium, it's considered to be relatively inocuous. Antibiotics are recommended just before dental work as most dental work can release bacteria into the blood.
If the cause of the MVP (mitral valve prolapse) is from previous infection, damage to the valve from other problems, etc, the bacteria can more easily take up residence in or near this valve. This is NOT a good thing and can lead to death.
The odds of it happening are pretty slim with congenital MVP with no regurgitation back into the atrium, but I always take my antibiotics before dental work or cleanings.
MVP can be clearly diagnosed with an echocardiogram. This is an ultrasound of the heart and it can measure the valve, how widely it opens and the degree of regurgitation if there is any.
This test is a walk in the park and it would be wise to get one done as a baseline study at least. It is in no way painful and is a piece of cake in my opinion.
Take your antibiotics for dental work. Tell your dentist and he will call in antibiotics. Tell him of all your drug allergies of course.
Carol Ann
Posts: 1062 | From CA USA | Registered: Jan 2001
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dontlikeliver
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Thanks Carol Ann,
My LLMD told me to hold the Ketek for 48 hours before dental work. I am not sure why, maybe something to do with that Ketek can affect heart rhythm? Would you be able to guess why he would give that advice? But, he did advice that 'after' (don't know how long after) I could take the ketek with Flagyl in place of a Penicillin drug as I had a bad reaction to Penicillin last week, which I don't yet know if it's an allergy, but it was so scary I am not sure I want to try again to find out (the emergency doc said no more Penicillin).
So, if you take abx for dental work, how long before any work do you ahve to start the abx? Or can you start the abx after?
I suspect I was born with the murmur. And, I did have an echocardiogram (isn't that the one they do with ultrasound?) a few years ago, nobody said it showed anything abnormal.
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breathwork
Frequent Contributor (1K+ posts)
Member # 567
posted
The dental association recommends that you take a loading dose of antibiotic a few hours ahead of the appointment and another dose after....at least that's what I remember.
When I told my dentist what antibiotics I was on, he told me to stop them for a couple of days before the appt too...
Then take the ones he prescribed for the appointment.
I assume that he had me stop my lyme drugs to protect my liver from so many drugs at one time.
Ask your dentist these questions too....
Penecillin is the drug of choice for dental prophylaxis, but there are others that he can prescribe if you have problems with penecillin...
Carol Ann
Posts: 1062 | From CA USA | Registered: Jan 2001
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5dana8
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Member # 7935
posted
hey dontlikeliver I also have MVP. and my dentist has always had me take abx before and afterwards,even a clean.
The reason is people with MVP have a chance of any bacteria going from mouth to heart durning dental procedures.
Your dentist should be made aware of your condition if he hasn't already.
Interestingly enough over the 20 years with treatment, my last echo , the MVP is almost gone. I don't know how this can be, but it is.
Take care.
-------------------- 5dana8 Posts: 4432 | From some where over the rainbow | Registered: Sep 2005
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dontlikeliver
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Member # 4749
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Thanks Carol Anne and Dana,
I mentioned my confusion about the heart murmur to the dentist when he examined me two weeks ago to see what needed to be done to my tooth.
He said he would call my GP and ask him. In the meantime, I saw my GP and asked him myself and his answer was 'well, it depends on what kind of murmur you have'. That was his only answer when I asked if I needed abx before dental work and that I had been told on several occasions that I had a harmless murmur, and that one doctor in the last 15 years advised abx as precaution. So, my GP's answer was not really an answer, and I imagine he will be just as forthcoming to my dentist, which is why I'm trying to figure it out myself. Although, not sure I can do that.
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posted
Dana said: >> Interestingly enough over the 20 years with treatment, my last echo , the MVP is almost gone. I don't know how this can be, but it is.
This happened to me, too. I was diagnosed, by echoes, with MVP in college and then again at age 25.
In 1994, a doctor told me that I had a heart murmur but it did not sound like the kind that required antibiotics for dental work. I had another ultrasound and the doctor said, "There is nothing wrong with your heart."
I wanted to be sure, so I had another ultrasound in 2004. Same thing. Nothing wrong with my heart.
No one has been able to explain to me why MVP would go away. It's not supposed to do that.
I did ask the last cardiologist if it might be that the technology has improved such that they can see things more clearly now, and perhaps I never did have MVP. He thought that might be a possibility, but really didn't know.
Regardless, I have had a heart murmur since birth, and except for the early days, no one has ever been concerned about it, so neither am I.
-------------------- Suzanne Shaps STAND UP FOR LYME Texas (www.standupforlyme.org) (Please email all correspondence related to protecting Texas LLMDs to [email protected] with copy to [email protected]) Posts: 977 | From Austin, TX, USA | Registered: May 2004
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map1131
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Gum disease or any bacteria under the gums in mouth can lead to heart disease, cancer, chronic illness.
The mouth and total body health is one in the same.
Pam
-------------------- "Never, never, never, never, never give up" Winston Churchill Posts: 6478 | From Louisville, Ky | Registered: Jan 2002
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posted
Yes I do and it is very imprtant that you take abx for any dental work....
Bacteria can get on the mitral valve and cause infection...this is the reason why people with this problem end up needing valve replacements later in life...
Taking abx before procedures will stop that risk from happening. I carry a card with me that my cardio gave me that states I need abx treatment for any invasive procedure....
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dontlikeliver
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So Christine I guess that you were not told, like the majority of us here so far, that your heart murmur is the 'harmless' kind (?).
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GiGi
Frequent Contributor (5K+ posts)
Member # 259
posted
Wisdom teeth sites and heart are closely related. Very, very closely. Even if you don't have the wisdom teeth any longer.
You might want to have them checked by a professional who can interpret an x-ray or panoramic x-ray. Most regular dentists are not able to do that! They simply don't know how and what to look for.
I posted a dental chart recently that shows the connection between our different organs with the different teeth. You might want to take a look.
Take care.
Posts: 9834 | From Washington State | Registered: Oct 2000
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posted
Since I was twelve I remember being in the hospital with heart palpitations and doctors telling me nothing was wrong with my heart.
In my 30's I had an echocardiogram and the doctor said I might have MVP but not enough to have to worry about it or mention on my insurance.
Fast forward 15 years later, I wore a holter monitor to try to catch all the irregular beats I felt and they said it was nothing to worry about my heart was nice and strong.
Now could all this be lyme related? Can lyme mimic these heart issues just like it mimics MS, Lupus, ALS, FM/CFS and other illnesses?
dontlikeliver
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posted
I wonder that too Karatelady.
I have had palpitations for years, skips for the last 3-4 and more recently skips are brought on, sometimes, by light exercise or carrying a shopping basket. Is that harmless? I have had a couple of EKG's recently, nothing showed abnormal.
I had an echocardiagram maybe 8 years ago, normal as far as I remember. I'd remember if it was abnormal.
I wore a holter monitor around 8 years ago also, normal.
So, does one assume that increasing heart stuff is just and extension of Lyme mimicking something else, but once harmless always harmless.
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posted
Well, I developed mitral valve prolapse about 20 years ago, but it began to worsen about 5-6 years ago just when I was diagnosed with MS due to my negative lyme tests. And this Wednesday I'm having mitral valve repair surgery as the regurgitation is very bad. The doctor said I could go into congestive heart failure if I don't fix it.
Is this the result of untreated lyme disease?
Posts: 34 | From New York State | Registered: Oct 2005
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breathwork
Frequent Contributor (1K+ posts)
Member # 567
posted
On the outside chance that your cardiac surgeon might agree, ask him to take a biopsy of the valve tissue for you to have tested for lyme. Or just ask for a sample of the valve tissue for you to have tested independently.
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dontlikeliver
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posted
Went to see my GP yesterday.
He listened to my heart and said the murmur I have is 'very soft' and that nowadays abx for dental tx are much more rarely given. He did not think mine is anything to worry about.
DLL
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klutzo
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My understanding from reading Dr. K, is that 75% of us develop an MVP, usually in the second year of our illness. This is associated with our Magnesium deficiency, and needs to be aggressively tx'd with Mg, 600-1,200 mgs. daily.
I know of two people who caught it early enough and reversed it with Mg.
That is exactly when mine started (in the 2nd yr.). I now have 3 prolapsed valves, and 2 conduction problems.
My husband, who has a genetic MVP, has taken ABX at the dentist for decades, but nevertheless,now has an enlarged left atrium and is going to need a valve repair, since his ejection fraction is heading for heart failure.
Genetic MVP is associated with other traits, while the acquired type that comes with Lyme is not. My husband and two of my female friends have genetic MVP's, and all of them fit the genetic type.
They are unusually tall, thin, narrow chested, flat backed, with large hands and feet.
Endometriosis, scoliosis, migraine, and Irritable Bowel Syndrome are also more common in MVP patients.
Klutzo
Posts: 1269 | From Clearwater, Florida, USA | Registered: May 2004
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breathwork
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Member # 567
posted
The type that you are referring to is a Marfans Syndrome body type. It's suspected that Abraham Lincoln had Marfans. They tend to have longer pear-shaped body types with longer faces, and larger hands and feet.
There are other congenital causes of Mitral Valve Prolapse as well. Usually it's an elongated tendon called the cordae tendonae..which is the tendon that holds the leaf-like valve in place. When it's a bit longer than needed it flaps more than usual with each heartbeat causing the mid systolic click sound that indicates MVP.
This sort of MVP tends to occur in body types including tall fair haired and skinned people. A long, more straight body type. Think of a tall lanky Irish lass...
This sort of MVP is usually benign, while the Marfans Syndrome type of MVP can have cause for concern, as you have indicated.
Another etiology for MVP is rheumatic fever or infection after strep or other infections of the heart. This sort of problem actually damages the valve leaflets causing the MVP. This is why your mother always made you take all of your medication when you had strep throat, to avoid cardiac problems later.
The need for antibiotics for dental procedures is somewhat correlated with the etiology of the MVP itself. The level of regurgitation is also a consideration.
Years ago antibiotics were prescribed for dental work for all types of MVP, whereas today, congenital MVP is usually not considered as big a risk as say Marfans or damaged valves from previous cardiac infections.
Your dentist and primary care doc make the call as to when to use antibiotics for dental work.
Posts: 1062 | From CA USA | Registered: Jan 2001
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posted
From what I understand whether you have a severe, moderate or mild case of MVP, Murmur or both its important to pretreat with abx... Its always better safe than sorry.
Posts: 437 | Registered: Sep 2004
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chroniclymie
Unregistered
posted
First the drug of choice perfered by the american heart association for mitral valve prolapse is presently 1 gm amoxycillin 1 hour prior to appoint and none after, however with lyme i would reccomend at least two doses after of 500mg each. for major surgery, gums ,extractions root canals, i would be more aggressive and take 2 days before and 3 days after. this is not the aha dosage but my experience working on imunocompromised patients over 23 years. the treatment is self is very invasive to somebody with a compromised immune system and premed is necessary. in actuallity only heart murmurs related or caused by scarlet fever or especially rheumatic fever and mitral valve prolapse. However, the reason for many heart murmurs are unknown and precautions should be on the side of the agressive rather than non. the last thing you want from dental treatment is SBE subacute bacteria endocarditis.this has no treatment and will kill in most cases. also needing premedication: any artificial joint, ie hip, knee, shoulder any artificial stents or teflon implants from aorta and hernia operations. basically anything foreign is susceptable to getting infectin from dental treatemnt and also any surgery.
so if any question take abx. questionable whether you should stop lyme abx or just go on top of it. when i go with my mitral vavle i go over top and take both abx since the second is only 2-3 doses.
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dontlikeliver
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thanks ChronicLyme,
I was all 'prepared' to take Amoxicillin or similar, but now I am allergic to it.
Neither my GP or dentist know if Ketek is OK or sufficient to take for these kinds or procedures, and now my dentist said I don't need to take anything. So, in other words, I have Amoxicillin at home, but can't take it. I have ketek, which I now have been told to STOP instead for the treatment (rather than stay on it).
For people who are allergic to Penicillin, what other abx would you/have you taken if you have a heart murmur?
Well, basically my ONLY choice now is just to either take nothing as per my dentists advice, or continue with my Ketek for Lyme and hope that A) doesn't interact with novocain or something and B) covers the kind of infection I'd want to prevent.
DLL
Posts: 2824 | From The Back of Beyond | Registered: Oct 2003
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I too have a congenital valve problem (not MVP) but does cause a murmur. I took 2 Gm. Amoxicillin 1 hour prior to procedures, including cleanings, and just 1 dose.
I remember while on Ceftin I was told I wasn't covered with that, so took both (usually cuased a moderate Herx reaction too).
Since I've been on Bicillin LA I don't have to take the Amoxicillin.
My suggestion would be to call your dentist and see what they give their other pts. who can't take PCN. My cardiologist perscribes mine both I think the dentist can too.
I have to go next week for root canal therapy for an abcessed tooth...Your question raises an important question for me. Since I have an infected tooth while I'm on Bicillin (only q3weeks) and Biaxin 3xd, maybe I need something else in case I'm dealing with a resistant bacteria!
Thank you...I think I'll go call my dentist now!
-------------------- "Courage is the mastery of fear-not the absence of it."-Mark Twain
Still trying hard to be brave...Deb Posts: 82 | From Upstate NY | Registered: Oct 2003
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I just want to add that if you look at Dr. B's symptoms list, you'll see MVP.
I have recently developed it too. I'm supposed to take 1 gram of amox 1 hour before dental work of any kind.
Actually, cardiologist said prior to surgery. My dentist said prior to any dental work including cleanings.
I didn't do it before my last cleaning and I'm still alive. My gums don't bleed much though. The hygenist said that if they did, I'd be in trouble.
I know clindimycin is known for helping to heal dental infections quickly. Maybe you could use that.
Hope this helps,
Corgilla
-------------------- "I'll never forget good old Whatsisname." Posts: 694 | From PA | Registered: Jun 2003
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chroniclymie
Unregistered
posted
AMERICAN HEART ASSOCIATION REGIME FOR PROPHYLAXIS FOR SBE
February 28, 2006
Endocarditis Prophylaxis Information
If you have congenital heart disease, print out this information and give it to your physician. You can also download a PDF version of the wallet card. Healthcare Professionals: Please see below for reference to the complete statement.
Dental procedures for which endocarditis prophylaxis is recommended1
Dental extractions
Periodontal procedures including surgery, scaling, and root planing, probing, and recall maintenance
Endodontic (root canal) instrumentation or surgery only beyond the apex
Subgingival placement of antibiotic fibers or strips
Initial placement of orthodontic bands but not brackets
Intraligamentary local anesthetic injections
Prophylactic cleaning of teeth or implants where bleeding is anticipated
1Prophylaxis is recommended for patients with high- and moderate-risk cardiac conditions
Prophylactic Regimens for Dental, Oral, Respiratory Tract, or Esophageal Procedures. (Follow-up dose no longer recommended.) Total children's dose should not exceed adult dose.
I. Standard general prophylaxis for patients at risk: Amoxicillin: Adults, 2.0 g (children, 50 mg/kg) given orally one hour before procedure.
II. Unable to take oral medications: Ampicillin: Adults, 2.0 g (children 50 mg/kg) given IM or IV within 30 minutes before procedure.
III. Amoxicillin/ampicillin/penicillin allergic patients: Clindamycin: Adults, 600 mg (children 20 mg/kg) given orally one hour before procedure. -OR- Cephalexin* or Cefadroxil*: Adults, 2.0 g (children 50 mg/kg) orally one hour before procedure. -OR- Azithromycin or Clarithromycin: Adults, 500 mg (children 15 mg/kg) orally one hour before procedure.
IV. Amoxicillin/ampicillin/penicillin allergic patients unable to take oral medications: Clindamycin: Adults, 600 mg (children 20 mg/kg) IV within 30 minutes before procedure. -OR- Cefazolin*: Adults, 1.0 g (children 25 mg/kg) IM or IV within 30 minutes before procedure.
*Cephalosporins should not be used in patients with immediate-type hypersensitivity reaction to penicillins.
Prophylactic Regimens for Genitourinary/Gastrointestinal Procedures:
I. High-risk patients:
Ampicillin plus gentamicin: Ampicillin (adults, 2.0 g; children 50 mg/kg) plus gentamicin 1.5 mg/kg (for both adults and children, not to exceed 120 mg) IM or IV within 30 minutes before starting procedure. 6 hours later, ampicillin (adults, 1.0 g; children, 25 mg/kg) IM or IV, or amoxicillin (adults, 1.0 g; children, 25 mg/kg) orally.
II. High-risk patients allergic to ampicillin/amoxicillin:
Vancomycin plus gentamicin: Vancomycin (adults, 1.0 g; children, 20 mg/kg) IV over 1-2 hours plus gentamicin 1.5 mg/kg (for both adults and children, not to exceed 120 mg) IM or IV. Complete injection/infusion within 30 minutes before starting procedure.
III. Moderate-risk patients:
Amoxicillin: Adults, 2.0 g (children 50 mg/kg) orally one hour before procedure -OR- Ampicillin: Adults, 2.0 g (children 50 mg/kg) IM or IV within 30 minutes before starting procedure.
IV. Moderate-risk patients allergic to ampicillin/amoxicillin:
Vancomycin: Adults, 1.0 g (children 20 mg/kg) IV over 1-2 hours. Complete infusion within 30 minutes of starting the procedure.
NOTE: For patients already taking an antibiotic, or for other special situations, please refer to the full statement referenced below.
Adapted from Prevention of Bacterial Endocarditis: Recommendations by the American Heart Association by the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease. JAMA 1997, 277:1794-1801, Circulation 1997, 96:358-366, and JADA 1997, 128:1142-1150.
Health Care Professionals -- Please refer to these recommendations (endorsed by the American Dental Association and American Society for Gastrointestinal Endoscopy) for more complete information as to which patients and which procedures need prophylaxis.
The Council on Dental Therapeutics of the American Dental Association has approved this statement as it relates to dentistry.
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Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements American Dental Association; American Academy of Orthopaedic Surgeons
An expert panel of dentists, orthopaedic surgeons and infectious disease specialists, convened by the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) performed a thorough review of all available data to determine the need for antibiotic prophylaxis to prevent hematogenous prosthetic joint infections in dental patients who have undergone total joint arthroplasties. The result is this report, which has been adopted by both organizations as an advisory statement. The panel's conclusion: Antibiotic prophylaxis is not indicated for dental patients with pins, plates and screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients (Table 1) who may be at potential increased risk of hematogenous total joint infection.
Approximately 450,000 total joint arthroplasties are performed annually in the United States. Deep infections of these total joint replacements usually result in failure of the initial operation and the need for extensive revision. Due to the use of perioperative antibiotic prophylaxis and other technical advances, deep infection occurring in the immediate postoperative period resulting from intraoperative contamination has been markedly reduced in the past 20 years.
Patients who are about to have a total joint arthroplasty should be in good dental health prior to surgery and should be encouraged to seek professional dental care if necessary. Patients who already have had a total joint arthroplasty should perform effective daily oral hygiene procedures to remove plaque (e.g. manual or powered toothbrushes, interdental cleaners, oral irrigators) to establish and maintain good oral health. The risk of bacteremia is far more substantial in a mouth with ongoing inflammation than in one that is healthy and employing these home-oral hygiene devices.1
Bacteremias can cause hematogenous seeding of total joint implants, both in the early postoperative period and for many years following implantation.2 It appears that the most critical period is up to two years after joint placement.3 In addition, bacteremias may occur in the course of normal daily life4-6 and concurrently with dental and medical procedures.6 It is likely that many more oral bacteremias are spontaneously induced by daily events than are dental treatment-induced.6 Presently, no scientific evidence supports the position that antibiotic prophylaxis to prevent hematogenous infections is required prior to dental treatment in patients with total joint prostheses.1 The risk/benefit7,8 and cost/effectiveness7,9 ratios fail to justify the administration of routine antibiotic prophylaxis. The analogy of late prosthetic joint infections with infective endocarditis is invalid as the anatomy, blood supply, microorganisms and mechanisms of infection are all different.10
It is likely that bacteremias associated with acute infection in the oral cavity,11,12 skin, respiratory, gastrointestinal and urogenital systems and/or other sites can and do cause late implant infection.12 Any patient with a total joint prosthesis with acute orofacial infection should be vigorously treated as any other patient with elimination of the source of the infection (incision and drainage, endodontics, extraction) and appropriate therapeutic antibiotics when indicated.1,12 Practitioners should maintain a high index of suspicion for any unusual signs and symptoms (e.g. fever, swelling, pain, joint warm to touch) in patients with total joint prostheses.
Antibiotic prophylaxis is not indicated for dental patients with pins, plates and screws, nor is it routinely indicated for most dental patients with total joint replacements. This position agrees with that taken by the Council on Dental Therapeutics,13 the American Academy of Oral Medicine,14 and is similar to that taken by the British Society for Antimicrobial Chemotherapy.15 There is limited evidence that some immunocompromised patients with total joint replacements (Table 1) may be at higher risk for hematogenous infections.13, 16-22 Antibiotic prophylaxis for such patients undergoing dental procedures with a higher bacteremic risk (as defined in Table 2), should be considered using an empirical regimen (Table 3). In addition, antibiotic prophylaxis may be considered when the higher risk dental procedures (as defined in Table 2) are performed on dental patients within two years post implant surgery,3 on those who have had previous prosthetic joint infections, and on those with some other conditions (Table 1).
Occasionally, a patient with a total joint prosthesis may present to the dentist with a recommendation from his/her physician that is not consistent with these guidelines. This could be due to lack of familiarity with the guidelines or to special considerations about the patient's medical condition which are not known to the dentist. In this situation, the dentist is encouraged to consult with the physician to determine if there are any special considerations that might affect the dentist's decision on whether or not to premedicate, and may wish to share a copy of these guidelines with the physician, if appropriate. After this consultation, the dentist may decide to follow the physician's recommendation, or, if in the dentist's professional judgment, antibiotic prophylaxis is not indicated, may decide to proceed without antibiotic prophylaxis. The dentist is ultimately responsible for making treatment recommendations for his/her patients based on the dentist's professional judgment. Any perceived potential benefit of antibiotic prophylaxis must be weighed against the known risks of antibiotic toxicity, allergy, and development, selection and transmission of microbial resistance.
This statement provides guidelines to supplement practitioners in their clinical judgment regarding antibiotic prophylaxis for dental patients with a total joint prosthesis. It is not intended as the standard of care nor as a substitute for clinical judgment as it is impossible to make recommendations for all conceivable clinical situations in which bacteremias originating from the oral cavity may occur. Practitioners must exercise their own clinical judgment in determining whether or not antibiotic prophylaxis is appropriate.
The ADA/AAOS Expert Panel consisted of: Robert H. Fitzgerald Jr., MD; Jed J. Jacobson, DDS, MS, MPH; James V. Luck Jr., MD; Carl L. Nelson, MD; J. Phillip Nelson, MD; Douglas R. Osmon, MD; and Thomas J. Pallasch, DDS. Staff Liaisons: ADA-Clifford W. Whall Jr., PhD; AAOS-William W. Tipton Jr., MD.
Table 1. Patients at Potential Increased Risk of Hematogenous Total Joint Infection12,16-22
All patients during the first two (2) years after prosthetic joint replacement. Immunocompromised/immunosuppressed patients Inflammatory arthropathies (e.g.: rheumatoid arthritis, systemic lupus erythematosus) Drug -induced immunosuppression Radiation-induced immunosuppression Patients with co-morbidities (e.g.) Previous prosthetic joint infections Malnourishment Hemophilia HIV infection Insulin-dependent (Type 1) diabetes Malignancy Table 2. Incidence Stratification of Bacteremic Dental Procedures*
HIGHER INCIDENCE1
Dental extractions Periodontal procedures including surgery, subgingival placement of antibiotic fibers/strips, scaling and root planing, probing, recall maintenance Dental implant placement and replantation of avulsed teeth Endodontic (root canal) instrumentation or surgery only beyond the apex Initial placement of orthodontic bands but not brackets Intraligamentary and intraosseous local anesthetic injections Prophylactic cleaning of teeth or implants where bleeding is anticipated LOWER INCIDENCE2
Clinical judgment may indicate antibiotic use in selected circumstances that may create significant bleeding. Restorative dentistry2 (operative and prosthodontic) with/without retraction cord Local anesthetic injections (nonintraligamentary and nonintraosseous) Intracanal endodontic treatment; post-placement and buildup Placement of rubber dam Postoperative suture removal Placement of removable prosthodontic/orthodontic appliances Taking of oral impressions Fluoride treatments Taking of oral radiographs Orthodontic appliance adjustment
This includes restoration of carious (decayed) or missing teeth. *Adapted from: Prevention of Bacterial Endocarditis: Recommendations by the American Heart Association, from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young. Reprinted with permission of the Journal of the American Medical Association.23
Patients not allergic to penicillin: cephalexin, cephradine or amoxicillin: 2 grams orally 1 hour prior to dental procedure.
Patients not allergic to penicillin and unable to take oral medications: cefazolin 1 gram or ampicillin 2 grams IM/IV 1 hour prior to the procedure.
Patients allergic to penicillin: clindamycin: 600 mg orally 1 hour prior to the dental procedure.
Patients allergic to penicillin and unable to take oral medications: clindamycin 600 mg IV, 1 hour prior to the procedure.
*No second doses are recommended for any of these dosing regimens.
REFERENCES
Pallasch TJ, Slots J: Antibiotic prophylaxis and the medically compromised patient. Periodontology 2000 1996;10:107-138 Rubin R, Salvati EA, Lewis R: Infected total hip replacement after dental procedures. Oral Surg. 1976;41:13-23. Hanssen AD, Osmon DR, Nelson CL: Prevention of deep prosthetic joint infection. J Bone Joint Surg 1996;78-A(3):458-471. Bender IB, Naidorf IJ, Garvey GJ: Bacterial endocarditis: A consideration for physicians and dentists. J Amer Dent Assoc 1984;109:415-420. Everett ED, Hirschmann JV: Transient bacteremia and endocarditis prophylaxis: A review. Medicine 1977; 56:61-77. Guntheroth WG: How important are dental procedures as a cause of infective endocarditis? Amer J Cardiol 1984;54:797-801. Jacobson JJ, Schweitzer SO, DePorter DJ, Lee JJ: Antibiotic prophylaxis for dental patients with joint prostheses? A decision analysis. Int J Technol Assess Health Care 1990;6:569-587. Tsevat J, Durand-Zaleski I, Pauker SG: Cost-effectiveness of antibiotic prophylaxis for dental procedures in patients with artificial joints. Amer J Pub Health 1989;79:739-743. Norden CW: Prevention of bone and joint infections. Amer J Med 1985;78(Suppl 6B):229-232. McGowan DA: Dentistry and endocarditis. Br Dent J 1990;169:69. Bartzokas CA, Johnson R, Jane M, Martin MV, Pearce PK, Saw Y: Relation between mouth and haematogenous infections in total joint replacement. BMJ 1994;309:506-508. Ching DW, Gould IM, Rennie JA, Gibson PH: Prevention of late haematogenous infection in major prosthetic joints. J Antimicrob Chemother 1989;23:676-680. Council on Dental Therapeutics. Management of dental patients with prosthetic joints. J Amer Dent Assoc 1990;121:537-538. Eskinazi D, Rathburn W: Is systematic antimicrobial prophylaxis justified in dental patients with prosthetic joints? Oral Surg Oral Med Oral Pathol 1988;66:430-431. Cawson RA: Antibiotic prophylaxis for dental treatment: For hearts but not for prosthetic joints. Br Dent J 1992;304:933-934. Brause BD: Infections associated with prosthetic joints. Clin Rheum Dis 1986;12:523-536. Murray RP, Bourne WH, Fitzgerald RH: Metachronus infection in patients who have had more than one total joint arthroplasty. J Bone Joint Surg 1991;73-A:1469-1474. Poss R, Thornhill TS, Ewald FC, Thomas WH, Batte NJ, Sledge CB: Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop 1984;182:117-126. Jacobson JJ, Millard HD, Plezia R, Blankenship JR: Dental treatment and late prosthetic joint infections. Oral Surg Oral Med Oral Pathol 1986; 61:413-417. Johnson DP, Bannister GG: The outcome of infected arthroplasty of the knee. J Bone Joint Surg 1986;688:289-291. Jacobson JJ, Patel B, Asher G, Wooliscroft JO, Schaberg D: Oral Staphyloccus in elderly subjects with rheumatiod arthritis. J Amer Geriatr Soc 1997;45:1-5. Berbari EF, Hanssen AD, Duffy MC, Ilstrup DM, Harmsen WS, Osmon DR: Risk factors for prosthetic joint infection: case-control study. Clin Infectious Dis 1998; 27:1247-1254. Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST, Nouri S, Newburger JW, Hutto C, Pallasch TJ, Gage TW, Levison ME, Peter G, Zuccaro G: Prevention of bacterial endocarditis: Recommendations by the American Heart Association. From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young. JAMA 1997;277:1974-1801. Dentists and physicians are encouraged to reproduce the above Advisory Statement for distribution to colleagues. Permission to reprint the Advisory Statement is hereby granted by ADA and AAOS, provided that the Advisory Statement is reprinted in its entirety including citations and that such reprints contain a notice stating "Copyright �2002 American Dental Association and American Academy of Orthopaedic Surgeons. Reprinted with permission." If you wish to use the Advisory Statement in any other fashion, written permission must be obtained from the ADA and AAOS. Document Number: 1014
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