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Antibiotic treatment and dental procedures

Since the American Heart Association announced in April that it no longer recommends antibiotic treatment for the prevention of infective endocarditis in certain dental patients, one question that has frequently come up is whether patients who have undergone joint replacement still need to take antibiotics before dental procedures.

The answer is yes.

The American Dental Association and American Academy of Orthopaedic Surgeons still recommend that all patients take antibiotics during the first two years following total joint replacement before certain dental procedures, and beyond two years in immunocompromised patients and patients with certain related conditions.

The AHA and ADA recommend the use of antibiotics before dental procedures for patients with artificial heart valves, a previous history of endocarditis, certain congenital heart conditions and heart transplant patients who develop problems with a heart valve.

The guidelines no longer recommend antibiotic use for the following conditions : mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, or congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

The updated guidelines apply to many dental procedures, including teeth cleaning and extractions. The updated recommendations emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of developing infective endocarditis than taking preventive antibiotics before a dental visit.

The new recommendations are based on “a comprehensive review of published studies that suggest infective endocarditis is more likely to occur from bacteria entering the bloodstream as a result of everyday activities than from a dental procedure,” an AHA press release said.

For more information about antibiotic prophylaxis recommendations, visit the ADA Web site at “”.

©2010 American Dental Association. All rights reserved. Reproduction or republication is strictly prohibited without the prior written permission from the American Dental Association.

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