Should antibiotic prophylaxis be given to someone with heart complications?

Q.
I have recently been diagnosed with severe aortic stenosis caused by a congenital bicuspid aortic valve. I need some extensive dental procedures which may include at least one extraction, one or possibly two implants, a repaired or replaced crown and veneer, and a new crown or possibly a bridge. I am currently symptom free and not on any medications. Would you please advise me on any additional risks associated with any of the dental procedures mentioned. Also, do you recommend taking precautionary measures?
A.
The current protocol for patients with structural defects of their heart is not to routinely give antibiotic cover. It used to be thought that extracting a tooth increased the chance of bacterial endocarditis (infection of the heart wall with S.Viridans) . However brushing your teeth or chewing your food also produces this bacteraemia in your blood stream – this heart infection is in fact extremely rare and you should definitely continue brushing your teeth and chewing your food!

In 2005, we asked The National Institute for Health and Clinical Excellence (NICE) to
look at conflicting advice in relation to antibiotic prophylaxis against infective
endocarditis. In response to this NICE has developed a guideline on 'Prophylaxis
against Infective Endocarditis' which recommends that antibiotic prophylaxis should not
be given to adults and children with structural cardiac defects undergoing dental
interventional procedures. The full guideline can be found at www.nice.org.uk. This
new guidance is also contained in the current edition of the BNF (BNF 55, March
2008).

Hope this settles your mind to go ahead with your required dental treatment

dr julian caplan

Dr Julian Caplan – Director on the board of the BACD

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