Are Antibiotics Needed Before Major Dental Procedure? Dr. Johnson Responds

In 1955, the American Heart Association (AHA) recommended that patients with certain cardiovascular conditions accept a round of antibiotics prior to major dental work. That suggestion was revised in 2007. Here, Dr. Damon R. Johnson, an Edmond, OK, dentist with a special interest in overall patient health, speaks on the issue.

Q: Why have antibiotics historically been recommended before major dental work?

Dr. Damon R. Johnson, DDS, Edmond Dentist: In certain sects of the population – specifically people with underlying heart conditions – some advanced dental procedures have left them prone to contracting infective endocarditis. This is a form of endocarditis caused by bacteria entering the bloodstream and settling in the heart.

Q: Why did the AHA change its guidelines?

Dr. Damon R. Johnson, DDS, Edmond, OK, Dentist: As the safety of dental procedures increased over the years, the risk of infection was reduced. Antibiotics are now only recommended for patients with the highest risk – those with the most severe congenital heart conditions.

Q: What conditions warrant antibiotics?

Dr. Damon R. Johnson, DDS, Edmond Dentist: Patients who’ve previously had heart surgery to correct defects that present with persistent weaknesses including leakage, those with prosthetic devices installed in the six months prior to dental surgery, patients with abnormal heart valve function post-transplant, individuals with a history of endocarditis, and those who have had a prosthetic heart valve installed or repaired.

Q: Have the new guidelines resulted in an increase in infective endocarditis cases?

Dr. Damon R. Johnson, DDS, Edmond, OK, Dentist: According to a research study performed in cooperation with the Mayo Clinic, no. The study, however, was based on a very small, localized population. However, during the observational timeframe, there were fewer reported cases of infective endocarditis than in the years just prior.

Q: How many cases were identified during the study?

Dr. Damon R. Johnson, DDS, Edmond Dentist: It took place in Olmstead County, Minn., where there were 22 total cases of infective endocarditis identified between 1999 and 2010. Only three cases were reported after the guideline alterations. In all, two of the cases were deemed healthcare-acquired. The rest were found to be related to community exposure.

Education is the biggest employment sector in Edmond, including Edmond’s public schools and the University of Central Oklahoma.