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Too Few Heart Patients Take Antibiotics Before Dental Work


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July 5, 2000 -- Last year, 52-year-old Richard Collett was diagnosed with a heart condition called mitral valve prolapse and regurgitation.

Whenever he goes to the dentist, he is reminded of his condition, in which one of the heart valves is leaky and allows some blood to flow backward between beats. "My heart doctor recommended that I take antibiotics whenever I have dental work, so I always take the antibiotics as prescribed by my dentist," says Collett, a real estate manager from Tampa, Fla.

Like many Americans, he needs to take antibiotics before having dental work to prevent a potentially fatal heart infection. "I hate taking pills," Collett says. "But when it comes to my heart, I'm not taking any chances."

But too many of these people are taking chances, according to a study published in the Journal of the American Medical Association. Many who need antibiotics before having dental work aren't taking them, and other dental patients are taking antibiotics needlessly.

"The bottom line of our study is that about 40% of patients who need preventive antibiotics for dental work and similar procedures aren't taking them, and that 25% of patients who don't need them are taking them," researcher Warren J. Manning, MD, tells WebMD. Manning is an associate professor of medicine and radiology at Harvard Medical School.

In 1955, the American Heart Association (AHA) first recommended that patients with certain heart conditions -- including artificial, leaking, or thickened heart valves -- take antibiotics before dental work or other procedures in the mouth or intestinal tract where bleeding is likely. Bacteria released during these procedures can enter the bloodstream, and may lodge in the damaged heart valves, where they can infect the heart and release clumps of bacteria that can plug up blood vessels, causing strokes.

Fortunately, this heart disease, called endocarditis, is a very rare complication, and can easily be prevented by giving antibiotics to those most at risk. Unfortunately, it can be life threatening and difficult to treat. Since almost three-fourths of those who get endocarditis already have valve damage or other heart problems, the AHA recommends that these patients take antibiotics one hour before dental work or similar procedures.

In 1997, the AHA revised its guidelines to clarify which patients should receive antibiotics, and to recommend a simpler dosing schedule so patients would be more likely to take them. "Despite the intensive efforts of the AHA ... to make its 1997 guidelines as user friendly as possible, misconceptions remain," says Thomas J. Pallasch, DDS, MS. Pallasch, a professor of pharmacology and periodontics at the University of Southern California School of Dentistry in Los Angeles, reviewed the study for WebMD.

For example, Pallasch explains that "[some] dental treatment procedures not associated with significant bleeding no longer require antibiotics ... even in the highest-risk patients, and [the dentist is] the one to make this decision."

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Only 18.5% of Americans never floss. You are missing out on a simple way to make a big difference in the health of your mouth. Regardless of how well you brush, plaque still forms between your teeth and along your gums. Floss removes food trapped between the teeth and removes the film of bacteria that forms there before it turns to plaque, which can cause inflamed gums (gingivitis), cavities, and tooth loss. Try flossing just one tooth to get started.

You are one of 31% of Americans who don't floss daily. You are missing out on a simple way to make a big difference in the health of your mouth. Regardless of how well you brush, plaque still forms between your teeth and along your gums. Toothbrush bristles alone cannot clean effectively between these tight spaces. Flossing removes up to 80% of the film that hardens to plaque, which can cause inflamed gums (gingivitis), cavities, and tooth loss. Aim for 3 more days!

You are one of 31% of Americans who don't floss daily, but you're well on your way to making a positive impact on your teeth and gums. Regardless of how well you brush, plaque still forms between your teeth and along your gums. Toothbrush bristles alone cannot clean effectively between these tight spaces. Flossing removes up to 80% of the film that hardens to plaque, which can cause inflamed gums (gingivitis), cavities, and tooth loss. Aim for all 7 days!

Only 50.5% of Americans floss daily, and good for you that you are one of them! Regardless of how well you brush, plaque still forms between your teeth and along your gums. Toothbrush bristles alone cannot clean effectively between these tight spaces. Flossing removes up to 80% of the film that hardens to plaque, which can cause inflamed gums (gingivitis), cavities, and tooth loss. Congratulations on your good oral health habit!

SOURCES:

American Dental Association, Healthy People 2010

This tool is intended only for adults 18 and older.

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