If you are a patient with certain kinds of heart disease or special heart condition, or you've had a joint replaced, taking good care of your teeth and gums is a must - not just for a healthy smile, but also for your overall health.  In many situations, it is necessary for a patient with these medical conditions to take antibiotics prior to their dental care.

During dental treatment, bleeding sometimes occurs.  As a result, bacteria from the mouth can potentially enter the bloodstream and work their way to the heart.  This presents a risk for some persons with cardiac abnormalities because the bacteria may cause bacterial endocarditis, a serious, possibly life-threatening inflammation of the heart valves or tissues.  Antibiotics will significantly reduce this risk.

The American Heart Association routinely publishes guidelines so physicians and dentists can protect patients who are at risk for developing bacterial endocarditis.  The guidelines recommend the use of antibiotics prior to dental treatment based on the patient's medical condition and on the treatment to be performed.  Your dentist or physician may prescribe antibiotics for dental procedures that would result in bleeding from the gums or mucous membranes in the mouth.  This includes routine dental cleanings as well as more involved dental procedures

What types of heart conditions pose a risk?

Certain heart conditions are more often associated with endocarditis than others.  To determine if an existing heart condition poses a risk, your dentist needs complete health information on your medical history form.  The form should also include the name and address of your family physician or cardiologist as well as the names and dosages of all medications that you take.

Do any of these apply to you?

• Heart surgery within past six months 
• Pacemaker
• Vascular surgery (replaced artery) within past six months
• Artificial heart valve
• History of rheumatic fever
• History of heart murmur (mitral valve prolapse)
• Previous bacterial endocarditis
• Systemic pulmonary shunt
• Congenital heart defect
• Acquired valvular dysfunction

If you have any of these conditions, if you have been diagnosed with other heart ailments, or if your health status has changed since your last dental visit, tell your dentist as you may be a candidate for antibiotic pre-medication.

What about a joint replacement?

Joint replacements also often require antibiotics prior to dental care.  The bacteria commonly found in the mouth may travel through the bloodstream and settle in your artificial joint.  This increases your risk of contracting an infection.  For the first two years following a total joint placement, antibiotic prophylaxis is typically recommended for everyone.  After two years, only high-risk patients may need to receive antibiotics for high-risk procedures.  Your dentist will typically consult your orthopaedic surgeon for recommendations as to an appropriate course of treatment for you.

Other indications for antibiotic pre-medication beyond heart conditions and joint replacement can include medical conditions that cause you to be immunocompromised or immunosupressed, immunosupression caused by drug or radiation treatment, malnourishment, hemophilia and HIV infections.  All patients in these high-risk categories may need antibiotics for all high-risk dental procedures.

It is critically important for patients with any of the above conditions to take excellent care of their mouths.  If gum disease or other oral health concerns develop and bleeding occurs with a patient’s normal daily routines, the same medical concerns could occur.  Prevention of oral disease becomes even more important than ever.  Whatever your situation, a thorough medical history is important for your dentist to know.  Don’t think a condition doesn’t matter because it isn’t related to your mouth.  Often times that is one of the most important things your dentist needs to know!  Have a great 2005.