New Guidelines on Use of Antibiotics Before Dental Work

Q:  I am 78 years old and have mitral valve prolapse.

I previously received antibiotics for all of my dental procedures. I have had diarrhea and other reactions to amoxicillin which I took preventatively prior to dental work.

I recently read in a magazine that antibiotics are no longer required for most valve abnormalities. What are the current recommendations regarding antibiotics for dental procedures?

A:  The American Heart Association and its advisory committee recently came out with new guidelines for prevention of heart valve infections after certain procedures including dental work.

The guidelines were updated to reflect theories as to who gets heart valve infections and how.

The Heart Association's guidelines now state that endocarditis, infection of the heart valves, is much more likely to occur from transient bacteria that are released into the blood during daily activities such as brushing teeth or eating.

Antibiotics prior to procedures prevent an exceedingly small amount of endocarditis and actually may cause more adverse events, such as in your case.

Common heart valve defects like mitral valve prolapse no longer require antibiotic prophylaxis prior to dental procedures. In fact, the only heart abnormalities that require pre-procedure antibiotics are prosthetic (implanted) heart valves, previously infected heart valves, certain heart birth defects, and heart transplant patients with valve abnormalities.

For these valve problems, antibiotics are recommended for dental work and procedures involving the respiratory tract, and infected skin or musculoskeletal structures.

Deidre L. Faust, MD, is a Staff Physician (Internal Medicine) at the Medical College of Wisconsin's Plank Road Clinic. Her column appears in the Milwaukee Journal-Sentinel.