Antibiotics: Your Heart and Joints

Total Joint Replacement

Patients who have had artificial joints placed frequently need to take antibiotics prior to certain dental procedures. These people may be at risk of developing an infection at the site of the artificial joint due to bacteria that enter the bloodstream. Antibiotics reduce this risk. This is called antibiotic prophylaxis (pronounced pro-fuh-lax-iss).

When treating patients with artificial joint replacements, we follow the recommendations developed by the American Academy of Orthopedic Surgeons (AAOS), with input from the American Dental Association (ADA). The most recent recommendations are to have patients take antibiotics 1 hour prior to dental treatment if they have had a total joint replacement surgery (e.g., shoulder, knee, hip).

Prior to 2009, patients needed antibiotic prophylaxis for only 2 years after surgery. However, those recommendations have changed and patients should now take antibiotics prior to dental treatment for the rest of their lives.

Heart

For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. IE is an infection of the heart's inner lining or valves, which results when bacteria enter the bloodstream and travel to the heart.

The AHA's latest guidelines were published in its scientific journal in April 2007 with good news – they now recommend that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment. Guidelines are based on a growing body of evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe cases. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria, which are much more difficult to treat later in life.

The American Dental Association participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, or congenital heart conditions (e.g., a heart murmur).

Preventive antibiotics prior to dental procedures are advised for patients with artificial heart valves, history of infective endocarditis, specific, serious heart conditions (congenital heart disease), or a cardiac transplant (heart valve).

The new recommendations apply to many dental procedures, including cleanings and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs.

Patients and their families should also ask their health care providers careful questions anytime antibiotic are suggested before a medical or dental procedure.