Harvard Heart Letter

Pre-dental antibiotics for few, not many

There's no need for most people with heart disease or a valve problem to take antibiotics before having dental work. That's a reminder from the American Heart Association and the American College of Cardiology. In 2007, the two groups published a bold statement reversing a half century of advice. They reiterated that stance in updated guidelines for treating people with heart valve problems (Circulation, Aug. 19, 2008).

Doctors long worried that bleeding during dental work could let microbes from the mouth enter the bloodstream. If these critters settle down and start growing on the inner lining of the heart, the infection could damage heart valves and lead to other serious problems. This condition, called infective endocarditis, affects about 15,000 Americans each year. The conventional wisdom has long been to take a dose of antibiotics before having dental work.

It turns out that the small protection offered by antibiotics is far outweighed by the many upset stomachs, rashes, cases of diarrhea, and allergic reactions to the drugs. For most people, the best way to prevent endocarditis is to limit the growth of bacteria in the mouth by brushing and flossing every day and having regular check-ups with a dentist.

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