Cukingnan article #1 / 03-13-06

Why do some people need to be on prophylactic antibiotics during dental procedures?

Some patients who have heart conditions such as rheumatic fever are at a higher risk for developing bacterial infection of the heart valve referred to as endocarditis. However, since the incidence of rheumatic fever has decreased dramatically with the advent of antibiotics for streptococcal throat infection, this has become less of a problem with dental procedures.

Today, certain patients who have heart valve dysfunction such as aortic valve stenosis or significant mitral valve leak or regurgitation are particularly susceptible to bacterial infection during a dental procedure.

Another group of patients who are particularly susceptible to heart infection are those who already have artificial heart valves implanted or heart valve repairs. Any form of foreign object in the heart itself is subject to invasion by bacteria in the blood stream during dental procedures. The mouth is loaded with bacteria that can cause valve infection.

It has been shown in animal models and in humans that antibiotic prophylaxis is effective against the development of endocarditis. Certainly, other studies have refuted the benefit of prophylactic antibiotics during dental procedures.

As someone who deals with valve infection with frequency, I would recommend that a patient with a history of rheumatic fever or significant valve problems and patients with known valve repair or prosthesis should consult with their cardiologist or surgeon as far as antibiotic prophylaxis prior to dental procedures.

Ramon A. Cukingnan, M.D.

Diplomate, American Board of Thoracic and Cardiac Surgery

Member, South Bay Independent Physicians Medical Group, Inc.

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