Dental Health and Endocarditis Prevention

Endocarditis is a rare, life-threatening inflammation of the lining of the heart muscle and its valves. It is caused by a bacterial infection. Although it can occur in anyone, it is much more common in people with certain heart conditions and in those who've had it before. If your risk is high, you can take steps to lower it.

How Have Endocarditis Prevention Guidelines Changed?

In very rare cases, bacteria in the mouth may trigger endocarditis in people at higher risk. Here's what happens: Bacteria found in tooth plaque may multiply and cause gingivitis (gum disease). If not treated, this may become advanced. The gums become inflamed (red and swollen) and often bleed during tooth brushing, flossing, or certain dental procedures involving manipulation of the gums. When gums bleed, the bacteria can enter the bloodstream and can infect other parts of the body. In the case of endocarditis, this affects the inner lining of the heart and the surfaces of its valves. The bacteria stick to these surfaces and create growths or pockets of bacteria.

Because this is so rare, the new guidelines suggest antibiotics prior to dental procedures only for patients who are at highest risk for serious complications from endocarditis. In fact, in most cases, the risk of problems from antibiotics exceeds the benefits from preventive antibiotics. These attract blood products that may lead to clots.

Who Should Receive Antibiotics Before Having a Dental Treatment?

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To prevent endocarditis, patients with certain heart conditions receive a single dose of an antibiotic. You receive it about one hour prior to certain dental treatments.

The American Heart Association and American Dental Association now suggest that you receive antibiotics prior to dental treatment only if you have:

    Unrepaired cyanotic congenital heart disease (including those with devices that relieve symptoms only)Completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedureRepaired congenital heart disease with defects that remain at or near the site of a prosthetic patch or prosthetic device

What Dental Procedures Are Antibiotics Recommended For?

The new guidelines suggest preventive treatment for all patients with cardiac conditions listed above, but not for all dental procedures.

The guidelines suggest treatment only:

  • During dental procedures that involve manipulation of gingival tissue (around bone and teeth) or the periapical region of teeth (tip of the tooth root)
  • When the inside lining of the mouth is perforated

The guidelines do not recommend antibiotics for these dental procedures or events:

  • Routine anesthetic injections through noninfected tissue
  • Dental X-rays
  • Placement of removable prosthodontic or orthodontic appliances
  • Adjustment of orthodontic appliances
  • Placement of orthodontic brackets
  • Shedding of baby teeth
  • Bleeding from trauma to the lips or inside of the mouth

What Are the Symptoms of Endocarditis?

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Possible symptoms of endocarditis include:

  • Unexplained fever
  • Night chills
  • Weakness, muscle pain, or joint pain
  • Sluggishness (lethargy) or malaise (general ill feeling)

Keep in mind that receiving antibiotics greatly lowers the risk of endocarditis. However, it is not a guarantee. Also keep in mind that most cases of procedure- related endocarditis occur within two weeks of the procedure. So if you have any of these symptoms beyond this time, it is not very likely that you have endocarditis. It is always wise to check with your doctor or dentist if you have any concerns.

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