New Changes in Dental Prophylaxis
The American Heart Association has published the new recommendations that will spare thousands of patients from loading up on antibiotics before a trip to the dentist. For decades certain patients have been taking antibiotics for protection before dental procedures but now the rules have changed.
Infective endocarditis is a rare but life threatening condition that was thought to be prevented by patients taking antibiotics before dental procedures. I never knew that there was no scientific evidence on which to base those recommendations, but there wasn't. Doctors were taught to prescribe five days of antibiotics to certain "at risk" patients and in 1997 it was changed to a single dose of antibiotics. Many doctors still gave several doses despite the lack of evidence.
The new guidelines are a huge change from current practice. The only people who are recommended to receive the SINGLE DOSE of antibiotic are:
- Patients with prosthetic heart valves
- People with prior infective endocarditis
- People with unrepaired cyanotic congenital heart disease (rare, rare, rare)
- People with completely repaired heart disease with a prosthesis or catheter insertion within the past 6 months
- People with a repaired valve with residual defect on or near the repair
- People who have heart transplant who have developed a valve abnormality
This is welcome news to us primary care doctors and probably to dentists all over the world. It means no more letters and faxes from the dentist asking us to rush a prescription for antibiotics or sign off on the letter. It means no more echocardiograms to prove the murmer is "benign".
It proves that medicine is constantly evolving and changing and this is a change that will save both time and money for patients, dentists and physicians.