Too Few Heart Patients Take Antibiotics Before Dental Work
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
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
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