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Bacterial Endocarditis
Bacterial endocarditis is infection in the heart, specifically the heart valves. Certain dental procedures that cause significant bleeding and tissue damage are likely to trigger this dangerous infection, as a large number of bacteria flow through the bloodstream, land inside the heart, and foster infection.
The presence of certain heart conditions and defects will determine your relative risk of developing the infection. Antibiotics such as amoxicillin are used to try to prevent bacterial endocarditis in those who are at risk. The American Heart Association recommends that adults not allergic to penicillin take two grams of amoxicillin in capsule or liquid form one hour before certain dental procedures to prevent bacterial endocarditis.
The health conditions listed below put you at high or moderate risk for bacterial endocarditis. If you have one of these conditions, you should always start a course of antibiotics before undergoing a dental procedure that can release germs into the bloodstream:
- History of bacterial endocarditis
- Artificial cardiac valves
- Surgically constructed systemic pulmonary shunts or conduits
- Complex cyanotic congenital heart disease, such as single ventricle states, transposition of the great arteries, or tetralogy of Fallot
If you have one of the conditions below, you're at moderate risk and must take antibiotics before having dental procedures:
- Most other congenital cardiac malformations, other than the above and below
- Acquired heart valve problems, such as rheumatic heart disease
- Subaortic stenosis
- Mitral valve prolapse with valvular regurgitation and/or thickened heart valve leaflets
- Hypertrophic cardiomyopathy (also called I.H.S.S.)
Having one of the heart conditions below means you're at no special risk for endocarditis and most likely don't need antibiotics before you have dental work:
- Cardiac pacemakers and implanted defibrillators
- Previous rheumatic fever without resulting heart valve problems
- Surgical repair of atrial septal defects (ASD), ventricular septal defect (VSD), patent ductus arteriosis (PDA) (without complications after six months of age)
- Mitral valve prolapse (MVP)
- Physiologic, functional, or innocent heart murmurs
- Previous Kawasaki disease without resulting heart valve problems
- Previous rheumatic fever without resulting heart valve problems
- Isolated secundum atrial septal defect
Dental Procedures That Are Common Causes of Bacterial Endocarditis
- Dental extractions
- Periodontal procedures including surgery, scaling, and root planing; routine periodontal cleaning
- Dental implant placement and reimplantation of teeth that have been extracted
- Cleaning of teeth or implants where bleeding is anticipated
- Root canal instrumentation or surgery beyond the tip of the tooth
- Placement of antibiotic fibers/strips below the gum line
- Initial placement of orthodontic bands for braces, but not brackets
- Local anesthetic injections inside the ligaments
To be on the safe side, always discuss the risk of bacterial endocarditis with your dentist before having any dental work done. It is not necessary to take antibiotics before the following procedures unless the dentist thinks there will be significant bleeding:
- Fluoride treatments
- Oral X-rays
- Restorative dentistry, which may include filling cavities and replacing missing teeth, operative and prosthodontic, with/without use of a retraction cord
- Local anesthetic injections (not in the ligament)
- Root canal plus placements of posts and buildup
- Rubber dam placement
- Removal of stitches after dental surgery
- Placement of removable prosthodontic/orthodontic appliances
- Forming oral impressions
- Orthodontic appliance adjustment
Realize that correct antibiotic treatment will help prevent bacterial endocarditis. Remember, too, that if you develop a fever or other symptoms after having dental work, and especially if you're at risk for endocarditis, you must contact your physician immediately.
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