Reducing the Use of Antibiotics in Dentistry

For many years it's been routine dental practice to treat all patients with a history of rheumatic fever, mitral valve prolapsed, or other such problems with antibiotics.

It was believed that streptococcal bacteria in the mouth could enter the bloodstream during routine dental procedures, such as cleaning teeth that may induce a bleeding condition. These bacteria could lodge themselves in the valves of the heart leading to a condition known as valvular endocarditis.

The widespread use of antibiotics unfortunately presents many thousands of patients to antibiotics each year who are not ill. It also can present a special dilemma to patients who have yeast related illnesses.

Many suffer from mitral valve prolapse, a condition of the heart valve that puts them at "greater risk" for valve-related problems. However, they can also experience aggravation of their health when they're on antibiotics for any reason.

For decades, dentists have followed the routine prescribing of antibiotics during dental work almost without question. Since prescribing antibiotics to "at risk" patients undergoing routine dental procedures is the legal standard of practice, all doctors are expected, and obligated, to comply.

As a biological dentist, I've always worried about the amount of antibiotics given to our patients. There's no question that the heart must be protected at all cost. However, it is interesting to note the contents of a paper entitled "Preventing Bacterial Endocarditis: A Statement for the Dental Profession," written by the Council on Dental Therapeutics of the American Heart Association (AHA). It states that, "Endocarditis may occur specifically antibiotic prophylaxis …"

It also states, "Because no adequate, controlled clinical trials of antibiotic regimens for the prevention of bacterial endocarditis in humans have been done, recommendations are based on indirect information …"

Therefore, without comprehensive evidence, in April 2007, the AHA finally declined to change its position regarding prophylactic coverage for compromised dental patients.

If you have the following conditions and have taken prophylactic antibiotics routinely in the past, you no longer need them: mitral valve prolapsed, rheumatic heart disease, bicuspid valve disease or calcified aortic stenosis.

Who should still receive antibiotic prophylaxis? Those with an artificial cardiac valve, previous infectious endocarditis, congenital heart disease, or a cardiac transplant recipient who develops a cardiac valvulopathy.

As always, it is advisable to check with your physician to confirm this information on an individual basis This action taken by the AHA is definitely a step in the right direction. We must learn to reduce the amount of antibiotics that have been administrated in situations that can not substantiate its medicinal usage. This concerted effort brings the growing problem of antibiotic resistance that results from the overuse of these drugs.