Tooth Talk: Clarifying antibiotic needs

A couple of weeks ago I wrote about certain people needing to take antibiotics prior to having dental treatment. There have been many changes and much confusion about who needs and who doesn’t need pre-medication with antibiotics.

Today, I’m going to clarify that subject so that you can have a better understanding about the why, what and when of it all.

For many years people with certain types of heart problems have had to take antibiotics prior to having dental cleanings or certain types of dental procedures performed. The rise of MRSA, so-called super bugs and antibiotic resistance has led the American Heart Association to investigate the necessity for antibiotic therapy prior to dental treatment. In 2007, they decided to change the recommendations.

In the past the people that needed antibiotic pre-medication included those persons with the following:

n Mitral valve prolapse;

n Those with a history of rheumatic fever or rheumatic heart disease;

n Heart murmurs;

n Artificial heart valves.

The change in protocol was initiated because the ADA’s findings indicated that the risk of taking antibiotics prior to having dental treatment outweighed the benefits they were thought to provide.

Antibiotic resistance and the potential for adverse reaction were some of the other considerations that had been into account. The most obvious finding was that normal brushing and flossing can introduce bacteria into the bloodstream just as easily as any dental procedure. Therefore the recommendations were changed.

Currently there are only a small number of people for whom the risk of getting endocarditis is still high enough that they still need to take antibiotic pre-medication prior to dental treatment. Endocarditis is a very painful, potentially lethal infection that affects the heart and or heart valves. The people that still need to take antibiotics include the following:

n Any one with a history of endocarditis;

n Those with artificial heart valves;

n Certain specific congenital heart conditions and defects.

As always, I would advise anyone with any of the above conditions to consult with their physician or cardiologist prior to discontinuing their antibiotic regimen. Special circumstances may necessitate your physician or cardiologist to require the further use of antibiotic pre-medication.

Lastly, I would like to wish everyone a very, very happy holiday season and a wonderful new year. Please continue to e-mail and call with your questions. You can reach me at (239)389-9400 or on the web at

Questions can be sent to Fred Eck, D.D.S. at Marco Dental Care, 950 N. Collier Blvd., Suite 305, Marco Island; call 389-9400 or visit He received his Doctor of Dental Surgery at the University of Detroit Mercy and is licensed by the Florida State Board of Dentistry.

© 2008 All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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