Study tells dentists to cut the antibiotics
Dental patients do not need the preventive dose, a journal says
For decades, dentists have administered antibiotics before a tooth extraction or other procedure to prevent an infection that can spread to the heart.
But new guidelines by the American Heart Association say most patients do not need the antibiotics -- a reversal of a recommendation in effect for 50 years.
In fact, the dose could cause more harm than good, the AHA now says.
The guidelines, published recently in AHA's journal, are based on evidence from an ongoing scientific study, said Dr. Mark Greer, chief of the state Health Department's Dental Division.
"The big concern is overuse of antibiotics, which is creating a problem," he said, referring to increasing antibiotic resistance. "Evidence now supports using a much more conservative use of antibiotics."
It is now recommended that only people at the greatest risk should receive short-term antibiotics before routine dental procedures.
They include people with artificial heart valves, a history of previous endocarditis, certain serious congenital heart conditions and heart transplant patients who have a heart valve problem.
The AHA said antibiotics carry certain risks that outweigh benefits for most patients. Risks could include fatal allergic reactions and making the bacteria that cause the heart lining infection antibiotic-resistant.
Dr. Walter R. Wilson, professor of medicine at the Mayo Clinic in Rochester, Minn., said last month in an AHA scientific statement: "We've concluded that if giving prophylactic antibiotics prior to a dental procedure works at all -- and there's no evidence that it does work -- we should reserve that preventive treatment only for those people who would have the worst outcomes if they get IE (infective endocarditis).
"That's a profound change from previous recommendations."
A 1999 study estimated brushing teeth twice a day for a year posed a 154,000 times greater risk of exposure to blood-borne bacteria than a single tooth extraction, considered the most likely dental work to cause a bacterial infection, the AHA statement said.
Wilson said maintaining good oral health and hygiene appear to be more protective than antibiotics. "This changes the whole philosophy of how we have constructed these recommendations for the last 50 years."
Greer advised anyone who has been taking antibiotics regularly for dental work to consult their doctor and dentist.