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March 21st, 2011
09:54 AM ET

Do dentists still give antibiotics before cleaning teeth?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Mondays, it's pediatrician Dr. Jennifer Shu.

Asked by Janet, Leeds

I have a heart murmur and until recently my dentist said I needed antibiotics when I had my teeth cleaned. When did this recommendation change?

Expert answer

Thanks for your question. Since I do not know the nature of your heart murmur or extent of your dental work, I will provide some general information about antibiotics and dental procedures.

For certain heart conditions, antibiotics are recommended about one hour before invasive medical procedures to prevent a condition called infective endocarditis, which is a potentially life-threatening bacterial infection of the inner lining or valve within the heart.

In 2007 the American Heart Association changed the guidelines so that only people at highest risk for developing infective endocarditis are now advised to receive prophylactic antibiotics before invasive procedures.

The changes were made because it was discovered that infective endocarditis is more likely to occur after frequent exposure to bacteria from routine activities such as chewing food or brushing one's teeth than from occasional dental, gastrointestinal tract or genitourinary tract procedures. In addition, the risks of taking antibiotics were found to exceed the possible benefits to most people. These risks include allergic reactions, diarrhea, bowel infections and the development of bacteria that are highly resistant to available antibiotics.

Antibiotics for the purpose of endocarditis prevention are still recommended for high-risk patients undergoing certain invasive procedures involving the dental area, respiratory tract and infected skin or musculoskeletal tissues. This includes people with conditions such as an artificial heart valve, past history of endocarditis or a heart transplant with abnormal heart valve function. Individuals with certain birth defects of the heart that have not been completely repaired also fall into this higher-risk group.

People who require antibiotics before medical procedures may consider carrying a wallet card as well as making sure the need for such antibiotics is noted in their medical record.

Be sure to consult with your doctor and dentist if you have further questions about your own situation. Good luck!

Follow Dr. Shu on Twitter and on her blog, ParentingSense.


soundoff (27 Responses)
  1. fran drake

    Interesting...my 80 year old dad had a hip replacement and they want him to take antibiotics everytime he has dental work...I just wonder how long will this go on? It's been years now....

    March 21, 2011 at 11:20 | Report abuse | Reply
    • Chrissy

      That has to do with having metal in the body, whihc becomes a "magnet" of sorts for infections to gravitate towards. Kinda liek the heart lining issue, having metal implants can create a situation where introduced bacteria can gravitate there and cause issues. -Just an increased risk, but they give antibiotics for those folks as well as peopel with heart issues.
      I have orthopaedic screws in my knees and have had to take the antibiotics for years too.

      March 21, 2011 at 13:38 | Report abuse |
  2. hical

    what is the definition of "highest risk" patients for infective endocarditis?

    March 21, 2011 at 12:16 | Report abuse | Reply
    • tll

      My dad nearly died from infective endocarditis after getting his teeth cleaned, which he had done every 6 months just like the rest of us. The bacteria shut down his kidneys first and then colonized in his aortic valve & destroyed it. I guess the 'highest risk' patients are the ones who actually develop endocarditis. Seems a dangerous way to decide. He survived but has an artificial valve.

      March 21, 2011 at 13:09 | Report abuse |
    • tll

      Oh and today is his 81st birthday. :)

      March 21, 2011 at 13:10 | Report abuse |
  3. JB

    My college roommate's 20 year old boyfriend died, I understand, because he had a heart murmur and did not have antibiotics during his dental appointment. Having to worry about this must be a challenge.

    March 21, 2011 at 13:17 | Report abuse | Reply
  4. T's girl

    I am a 55 yr old woman and have mitro valave prelapse. Taken antiobotics for years prior to having my teeth cleaned. But recently my dentist said the new recommendations had changed so I talked w/my medical dr, who actually said she would continue to prescribe meds for me anyway if I wanted them. However, she suggested a new echo of my heart and found that over the past 5 yrs it has slightly changed for the worse. So dr and I both agreed we would continue the antibiotic regimen and I informed my dentist. No matter what the "recommendation" is, or what the outcome of the test would be, I feltt the meds were justified because I already knew I was in a higher risk category. Its YOUR body and should be YOUR decision.

    March 21, 2011 at 13:28 | Report abuse | Reply
    • Steve

      >> Its YOUR body and should be YOUR decision.

      This isn't true for any drug which, if overprescribed, will lose its benefit. This is especially true for antibiotics. In your case it sure sounds like you should keep taking them, but others who are at a lower risk are hurting us all – including themselves – if they demand unnecessary antibiotics.

      March 21, 2011 at 14:20 | Report abuse |
  5. judith

    Better to be safe than sorry. A friend of mine who happened to be a research PHD had a prolapsed mitrol valve and simple forgot to take the pre- and post meds,,, two days later her ex husband found her dead when he couldn't reach her... AND she had told the dentist she hadn't taken them, and apparently was told that would be fine, so she didn't take the post meds either.. all the RX was still at her home. Her husband, also a research PHD, had an autopsy done and she died because of the infection and no she wasn't considered by latest standards a high risk. My take, a little prevention could have saved this wonderful womans life!

    March 21, 2011 at 13:45 | Report abuse | Reply
  6. Hygiene

    One of the reasons the recommendations changed was the risk inherent in antibiotics themselves. Studies showed more people were dying of anaphylaxis than from infective endocarditis. As with so many things in medicine, there is no right or wrong; choices are made for the best statistical outcome.

    March 21, 2011 at 14:08 | Report abuse | Reply
  7. Allan

    When I was about 25 I started having pain around my heart area. I had all the tests done and no one could find anything wrong with me. I lived with this pain for about a month when I was given some Tetracycline for an unrelated illness. Within 2 days the pain around my heart was gone.

    March 21, 2011 at 15:05 | Report abuse | Reply
    • Hygiene

      It sounds like you had GERD (heart burn). Derivatives of tetracycline (Doxycycline) are used to treat the H. Pylori bacteria that causes GERD. Taking the antibiotic and having the reduction of symptoms makes it more likely you had reflux than cardiac infection.

      March 21, 2011 at 15:54 | Report abuse |
  8. becca

    regular dental checkups and cleanings are a must to keep teeth, gums, and mouth in great shape!

    March 21, 2011 at 15:14 | Report abuse | Reply
  9. TAT-2

    I have a heart murmur and have had one for 52 years..I am 52 years old and have also had Heart Surgery 49 years ago..I have NEVER taken anti biotics before any dental procedure and have been perfectly fine.. I truly believe each individual will have different reactions.....

    March 21, 2011 at 15:25 | Report abuse | Reply
  10. Me

    My husband had a heart murmur as a baby but 34 years later he still has to take antibiotics for it even though the heart murmur has gone away.

    March 21, 2011 at 15:35 | Report abuse | Reply
  11. gigivee

    I had knee replacement about 4 years ago and have to take antibiotcs before teeth cleaning or any other dental procedure. Also have never made it through the airport without haveing to have pat down and they never will look at the card I carry saying I have a knee replacement. Better safe than sorry.

    March 21, 2011 at 16:01 | Report abuse | Reply
  12. Andie

    I had rheumatic fever at the ages of 7 and 19. No damage was done to my heart as a result. However, I am still required to pre-medicate with 4 antibiotics approx 1 hour prior to getting any dental work. If the guidelines were changed in 2007, I would think that I would have already been notified if I wasn't considered "high risk" and didn't need the antibiotics any longer. I wonder why I would be considered high risk. Hmmmm.

    March 21, 2011 at 16:03 | Report abuse | Reply
  13. Dr. B

    Many fewer people need to premedicate following the June 2007 guidelines. Individuals with prosthetic joints (knees, hips etc) continue to need antibiotic prophylaxis. Additionally some patients on dialysis, active chemotherapy and post organ transplant ( compromised immune system) also need antiobiotic prophylaxis prior to invasive dental procedures. It is not necessary to premedicate to have an oral cancer screening, x-rays or impressons for braces, partials or dentures. The guidelines are quite specific. If you have any questions follow up with your dentist and physician.

    March 21, 2011 at 19:04 | Report abuse | Reply
  14. Doug Leen

    I take umbrage at Dr. Shu's final statement: "Be sure to consult with your doctor and dentist if you have further questions about your own situation. Good luck!"

    Dentists are doctors. Would it make equal sense to state "doctors and physicians?" How about Dr. Shu's specialty: "doctors and internists" or "doctors and surgeons?"

    March 21, 2011 at 22:06 | Report abuse | Reply
  15. Lisa

    Nobody likes going to the dentist, but the truth is that a man needs a dentist at least once a year because of teeth problems. If you live in Woodford or the surroundings, visit our website. We offer you a list of dental practices, located in and near Woodford.
    http://www.woodford-dentist.info/

    July 25, 2011 at 09:46 | Report abuse | Reply
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  20. Musandam Dibba

    Thanks for your question. Since I do not know the nature of your heart murmur or extent of your dental work, I will provide some general information about antibiotics and dental procedures.

    January 30, 2013 at 04:54 | Report abuse | Reply
  21. Brenda Harris

    I’d like to share my experience with your system, and it involves a question. A bit over a year ago, I went and got my teeth cleaned (first time in about years!). While there was no problem with caries, there was definitely inflammation and lots of tartar. It took two cleaning sessions and local anaesthetic to get the job done. That was about the time I started using your system. And I followed it to the dot, including a few grams of xylitol after each meal/snack. I should also mention that I rarely drink coffee/tea/soda/alcohol, and grain consumption is little to none.

    The results were impressive. At my next visit to the dentist, 8 months later, my gums were in excellent condition, and the cleaning was painless and easy. For the first time I can remember, my gums had a healthy pink look to them. The dentist was visibly surprised and asked me a bunch of questions about my routine. I personally thank placidway.com for finding me a doctor as great as him.

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