Endocarditis is a rare, life-threatening inflammation of the lining of the heart muscle and its valves. It is caused by a bacterial infection. Although it can occur in anyone, it is much more common in people with certain heart conditions and in those who've had it before. If your risk is high, you can take steps to lower it.
How Have Endocarditis Prevention Guidelines Changed?
In 2007, the American Heart Association Endocarditis Committee -- together with other experts -- issued guidelines to help prevent endocarditis. These replaced guidelines issued in 1997. After reviewing published studies, the committee found that only a small number of cases of infective endocarditis might be prevented by antibiotics for dental procedures. In patients with heart conditions associated with the highest risk of serious complications from endocarditis, it says that antibiotic treatment before dental procedures involving manipulation of the gums seems reasonable.
In very rare cases, bacteria in the mouth may trigger endocarditis in people at higher risk. Here's what happens: Bacteria found in tooth plaque may multiply and cause gingivitis (gum disease). If not treated, this may become advanced. The gums become inflamed (red and swollen) and often bleed during tooth brushing, flossing, or certain dental procedures involving manipulation of the gums. When gums bleed, the bacteria can enter the bloodstream and can infect other parts of the body. In the case of endocarditis, this affects the inner lining of the heart and the surfaces of its valves. The bacteria stick to these surfaces and create growths or pockets of bacteria.
Because this is so rare, the new guidelines suggest antibiotics prior to dental procedures only for patients who are at highest risk for serious complications from endocarditis. In fact, in most cases, the risk of problems from antibiotics exceeds the benefits from preventive antibiotics. These attract blood products that may lead to clots.
Who Should Receive Antibiotics Before Having a Dental Treatment?
To prevent endocarditis, patients with certain heart conditions receive a single dose of an antibiotic. You receive it about one hour prior to certain dental treatments.
The American Heart Association and American Dental Association now suggest that you receive antibiotics prior to dental treatment only if you have:
- Had bacterial endocarditis before
- A prosthetic (artificial) cardiac valve or prosthetic material used in valve repair
- Cardiac valve disease and have had a cardiac transplant
- Congenital (present at birth) heart disease. This includes only people with the following:
- Unrepaired cyanotic congenital heart disease (including those with devices that relieve symptoms only)
- Completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure
- Repaired congenital heart disease with defects that remain at or near the site of a prosthetic patch or prosthetic device
What Dental Procedures Are Antibiotics Recommended For?
The new guidelines suggest preventive treatment for all patients with cardiac conditions listed above, but not for all dental procedures.
The guidelines suggest treatment only:
- During dental procedures that involve manipulation of gingival tissue (around bone and teeth) or the periapical region of teeth (tip of the tooth root)
- When the inside lining of the mouth is perforated
The guidelines do not recommend antibiotics for these dental procedures or events:
- Routine anesthetic injections through noninfected tissue
- Dental X-rays
- Placement of removable prosthodontic or orthodontic appliances
- Adjustment of orthodontic appliances
- Placement of orthodontic brackets
- Shedding of baby teeth
- Bleeding from trauma to the lips or inside of the mouth
Is There Anything Else I Can Do to Lower My Risk for Bacterial Endocarditis?
- Tell your dentist if your health has changed since your last visit. Be sure to let your dentist know if you've had heart or vascular surgery within the past six months. Also report if you have been diagnosed with other heart conditions.
- Make sure your dentist has a complete list of the names and dosages of your medications, both prescription and over-the-counter.
- Make sure your dentist has the names and phone numbers of all of your doctors. Your dentist may want to consult with your doctor about your dental care plan and medication choices.
- Practice good oral hygiene. Brush your teeth at least twice a day; floss at least once daily; rinse with an antiseptic mouthwash at least once a day. Good oral and dental health is very important for patients at risk for endocarditis.
What Are the Symptoms of Endocarditis?
Possible symptoms of endocarditis include:
- Unexplained fever
- Night chills
- Weakness, muscle pain, or joint pain
- Sluggishness (lethargy) or malaise (general ill feeling)
Keep in mind that receiving antibiotics greatly lowers the risk of endocarditis. However, it is not a guarantee. Also keep in mind that most cases of procedure-related endocarditis occur within two weeks of the procedure. So if you have any of these symptoms beyond this time, it is not very likely that you have endocarditis. It is always wise to check with your doctor or dentist if you have any concerns.