GOOD oral health is more important than antibiotics in dental procedures for some heart patients to prevent a heart infection caused by bacteria around the teeth.
This is the advisory of a new American Heart Association (AHA) scientific statement published on April 15 in the AHA flagship journal, Circulation.
The scientific statement was prepared by the volunteer writing committee on behalf of the AHA Young Hearts Rheumatic Fever, Endocarditis and Kawasaki Disease Committee; the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; the Council on Cardiovascular and Stroke Nursing; and the Council on Quality of Care and Outcomes Research.
Infective Endocarditis (IE), or bacterial endocarditis, is not common. It is a heart infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel.
While rare, people with heart valve disease or previous valve surgery, congenital heart disease or recurrent infective endocarditis have a greater risk of complications when they develop IE.
Viridans group streptococcal infective endocarditis (VGS IE) is caused by bacteria that collect in plaque on the tooth surface and cause inflammation and swelling of the gums.
Certain dental procedures may increase the risk of developing VGS IE in vulnerable patients.
The new AHA guidance affirms previous recommendations that only four categories of heart patients should be prescribed antibiotics prior to certain dental procedures to prevent VGS IE due to their higher risk for complications from the infection.
These patients are those with prosthetic heart valves or prosthetic material used for valve repair; those who have had a previous case of infective endocarditis; adults and children with congenital heart disease; or people who have undergone a heart transplant.
Scientific data since the 2007 AHA guidelines support the view that limited use of preventive antibiotics for dental procedures hasn’t increased cases of endocarditis and is an important step at combating antibiotic overuse in the population, says Dr. Walter R. Wilson who led the group that wrote the statement. He is a consultant for the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic.
It has been over a decade since recommendations for preventing infective endocarditis were updated amid concerns of antibiotic resistance due to overprescribing.
The AHA 2007 guidelines, which presented the biggest shift in recommendations from the AHA on the prevention of infective endocarditis in more than 50 years, more tightly defined which patients should receive preventive antibiotics before certain dental procedures to the four high-risk categories.
The change resulted in about 90 percent fewer patients requiring antibiotics.
***
Dr. Joseph D. Lim is the former Associate Dean of the UE College of Dentistry, former Dean of the College of Dentistry, National University, past president and honorary fellow of the Asian Oral Implant Academy, and honorary fellow of the Japan College of Oral Implantologists. Honorary Life Member of Thai Association of Dental Implantology. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515./PN
