Dental Procedures in patients with heart disease

For long time now, physicians prescribed antibiotics for patients with certain heart diseases. These antibiotics were given shortly before the dental procedure to minimize the risk of infective endocarditis. Nowadays as more and more scientific studies are done, new recommendations for this policy are emerging to the surface. These studies explain that the use of antibiotic might be more dangerous to your body than the risk of developing infective endocarditis. Overuse of antibiotics without a real need for them can put you in a lot of troubles. Antibiotics can lead to severe allergic reactions and their misuse can lead to the development of new strains of bacteria that is resistant to these antibiotics and very difficult to treat.

The above studies have encouraged physicians and medical associations to change their guidelines for using antibiotics as a prophylaxis against infective endocarditis in patients with certain heart diseases who are planning to have a dental procedure.

In the past patients who suffered from mitral valve prolapse , rheumatic disease of heart valves, senile calcific aortic stenosis , congenital birth defects such as atrial septal defect were prescribed antibiotics before any dental procedure. Depending on recent studies, This group of patients should not receive any antibiotics before their dental procedures.

Who should receive antibiotics before dental procedure?

The recent guidelines focus on heart disease patients who can have a lot of troubles if they develop infective enodocarditis  of their hearts. Antibiotics are recommended for the following groups of patients:

1. Patients who have any of their heart valves replaced with an artificial heart valves.
2. Patients who developed an attack of infective endocarditis in the past.
3. Patients with congenital heart defects  whom their defect was repaired using a synthetic material such as a Dacron patch or in whom a device is used to close their defect whether surgical or using cardiac catheterization should receive antibiotic prophylaxis for 6 month after the procedure.
4. Patients with dangerous cyanotic congenital heart defects ( such as tetralogy of fallot) whom their defect was not repaired yet or incompletely repaired including those who received palliative shunt operation to improve their cyanosis.
5. Patients with congenital heart defects which were repaired using synthetic patches or mechanical devices, yet their repair was not perfect and there is still a residual defect after the repair
6. Patients who received a heart transplant and one of the valves, in this transplant, is diseased. Those patients are at high risk of infective endocarditis because of the immunosuppressive drug therapy.

The most common antibiotic that is used is amoxicillin which is given as a single dose before the dental procedure. Other antibiotics can be used if a patient is allergic to this antibiotic.

• The major means by which infective endocarditis can be minimized is to reduce the probability of bacteremia, reduce its magnitude when it does occur and use the most effective antibiotic in proper dosage for prophylaxis. Your primary goal to protect yourself from endocarditis is to follow excellent protective dental hygiene. Here are few tips that might help:
• Brush your teeth thoroughly each day. You should also use dental floss to remove food particles and plaque from places that you cannot reach with your brush, especially between teeth and near the gumline. Your dentist or hygienist will show you how to use the floss properly, since incorrect use can damage your gums. To check the efficiency of your cleaning, chew a disclosing tablet occasionally. The dye in the tablet colors the plaque in your teeth. Toothpicks should not be used to remove plaque, since they can easily damage your gums.
• Dental floss either waxed or unwaxed is thread that you draw between your teeth to remove plaque and food particles. Take about 45 cm of dental floss and wind most of it around the middle fingers of each hand, with about 2 between your fingers. Draw the floss between the teeth and, with a gentle sewing action, rub the sides of each tooth. Use a clean area of floss for each tooth.
• Reduce your sugar intake and eat a balanced diet. Beverages pass quickly through the mouth so they are not as harmful as sticky foods. Candy, other sweet snacks and refined carbohydrates between meals are especially harmful because after you eat or drink them your teeth are attacked for about 20 minutes by acid. Try to eat sweet foods only during meals. Better still, cut them out altogether and finish meals with nuts or cheese rather than with ice cream or cake. Cheese is particularly effective in neutralizing acid formats.
• Strengthen your tooth enamel with fluoride. The level of fluoride in the water should be between 0.7 and 1.2  parts per million, depending on the climate. Your dentist, local water authority or public health department can tell you what the fluoride level is in your community water supply. Also children under 3 should have fluoride applied to their teeth every year; because their enamel is still forming. Your dentist will advise you on the use of fluoride mouth wash or tablets, and may apply a fluoride gel to your teeth. In addition the family should use a fluoride toothpaste.
• See your dentist regularly. An examination and cleaning as often as your dentist recommends should ensure that any new cavity is filled before decaycan spread and any gum disease is treated before it can become serious.