February 17, 2019
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The Wealth of Health

George Malkemus
Antibiotics and your heart
June 22, 2018

If you have had to take antibiotics prior to dental treatment because of your heart condition, you may not need to any more. The 2014 guidelines from the American Heart Association recommend not taking antibiotics prior to dental treatment in most heart condition cases. You should contact your cardiologist, physician and dentist to see if you should stop or continue.

For decades, the American Heart Association [AHA] recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis [IE], an infection of the heart’s inner linings or valves. The idea was bacteria in the mouth could enter the blood stream during dental treatment and travel to the heart. It was thought that with a heart murmur, turbulence in the blood flow caused by the heart valve would allow the bacteria to eddy out and start a growth on the valve – not a good thing. However, a growing body of scientific evidence has shown this is not the case.

The scientific evidence shows that the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics and development of drug-resistant bacteria. Adverse reactions range from upset stomach, nausea and diarrhea to allergic reactions such as hives or life threatening anaphylactic shock. Allergic reactions to medications, as well as, foods, environmental substances including insect bites and stings can occur after years of never being allergic. If you have redness, swelling or itchiness after taking medication, stop future pills and call your doctor. If you have accelerating symptoms especially difficulty breathing, seek immediate emergency help, i.e., call 9-1-1. Use an epi-pen if available, which is found in some emergency kits or carried by people who are allergic to bee stings.

The over use of antibiotics causing the development of drug-resistant bacteria is another reason the AHA guidelines have changed. Drug-resistant bacteria are formed from antibiotic use. The inappropriate use of antibiotics increases the risk of drug-resistant forms and prevents their effectiveness when antibiotics are really needed.

Scientists also found no compelling evidence that taking antibiotics before a dental procedure prevents IE in patients who are at risk of developing a heart infection.  There is actually more exposure to bacteria from their mouths during basic daily activities such as eating, drinking, brushing or flossing. People with gum disease are at a much higher risk of having bacteria enter their bloodstream and causing infective endocarditis and heart disease. So a person’s best defense against IE is preventing gum disease through good oral hygiene, brushing and flossing, healthy diet and regular professional cleanings with a registered dental hygienist.

A bacterial infection of the gums, called periodontal disease, can affect the entire body. Gum disease is correlated with heart disease, diabetes, strokes, ulcers and pre-term births. Bacteria that build up between the tooth and gum can enter into the bloodstream when gums bleed. These bacteria can travel throughout the body and cause serious health problems. Periodontal disease can be prevented with good oral health habits; such as, brushing and flossing and regular professional cleanings.                                                                                                                                                                                

AHA Guidelines: 

Who should take Prophylactic Antibiotics before dental treatment:

The AHA guidelines state that patients who have taken prophylactic antibiotics routinely in the past, but no longer need them include people with mitral valve prolapse, rheumatic heart disease, calcified aortic stenosis, or most congenital [present from birth] heart conditions.

Certain heart conditions still require pre-medication with antibiotics in patients who would have the greatest danger of a bad outcome if they developed a heart infection. Preventive antibiotics before a dental procedure are advised for the following patients:

-Artificial heart valves

-A history of infective endocarditis

-Certain specific, serious congenital heart conditions

-A cardiac transplantation that develops a problem in a heart valve

If you have any of these heart conditions, you should consult your cardiologist for the use of antibiotics prior to dental procedures.

The new recommendations apply to any dental procedures that could involve possible bleeding in the gums or oral tissues. Antibiotic use prior to dental treatment is not necessary for an examination or x-rays, but is mandatory for teeth cleanings and oral surgery treatment like extractions.

The AHA guidelines emphasize that maintaining optimal oral health and practicing oral hygiene are more important in reducing the risk of infective endocarditis than is taking antibiotics before a dental visit. So keep brushing and flossing and have regular dental cleanings.


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at