We say these words almost every day. Our team here at Smile Sarasota is responsible for reminding our patients to take their premedication antibiotic or asking them at the appointment if they remembered to take it. So who needs to it? And why is this important? Infective (Bacterial) Endocarditis.
Infective endocarditis is a scary sounding condition. It happens when bacteria get into the bloodstream and end up infecting the lining of the heart, a heart valve or even a blood vessel. It’s a very uncommon infection. People who have certain heart conditions are clearly at greater risk than the rest of the population. But the one thing everyone seems to know is that dental treatment is almost always the cause. We know this because the mouth is full of bacteria, and dentists and hygienists cause bleeding with their treatment. So bacteria is definitely going to enter the bloodstream if you have dental treatment and if you are at greater risk for infective endocarditis, you better be careful.
So what have we done for dental patients with these heart conditions or those who have artificial joints? We preventively treat them with antibiotics. A LOT of antibiotics. We used to give them doses of antibiotics days before and after dental treatment. But then later the guidelines dictated dropping the dosage down to an hour before and several hours after. And now, we just give it an hour before. The American Heart Association has continued to change its guidelines for premedication to the point where we only rarely premedicate patients with certain very serious heart conditions. For instance, we premedicate people who have had a previous case of infective endocarditis. Also folks with prosthetic heart valves and a few other rare congenital heart problems.
But the American Heart Association continued to evaluate the evidence for taking a large dose of antibiotics prior to dental treatment and found little to no proof that the antibiotics prevented infective endocarditis. The AHA did what so many doctors, dentists and patients are unwilling or unable to do. They evaluated the evidence and changed their recommendations! At Smile Sarasota, we follow the 2007 AHA guidelines for the patients that require premedication for a heart condition or a joint replacement. A few patients who have been premedicating for a long time, find the change disconcerting. They assume that what they’ve been doing all along was correct and that the new recommendations are putting them at risk. However, most of these patients are tickled at the idea of not dealing with this premedication regimen. We usually receive and confirm the premedication recommendation from the patient’s medical doctor. So if you have been taking antibiotics before all of your dental appointments, and have questions, check with your cardiologist or your orthopedic professional to see if there has been a change in your particular case. Dr. Still goes by the recommendations of your MD.