For many years, the American Heart Association (AHA) has mandated that dentists give patients antibiotics before and after almost all dental procedures. The reason is that bacteria within the mouth during dental treatment can travel through the blood stream and cause a dangerous and sometimes-fatal heart infection called subacute bacterial endocarditis (SBE). Patients who are considered at high risk for developing SBE are people with artificial heart valves, have had SBE in the past, and have congenital (occurring at birth) heart defects. People at moderate risk include those who have damaged heart valves from diseases such as rheumatic heart disease, and who have mitral valve prolapse with regurgitation. People suffering from endocarditis develop fever, fatigue and shortness of breath. Untreated, the condition is often fatal. The theory is that by taking antibiotics before and after dental treatment, you can kill the bacteria before it can infect the heart of susceptible patients.

In today's fast-paced culture, we are sometimes geared to look for the quick fix, the cure in a bottle. This has given some people the impression that antibiotics are akin to vitamins- but they are not. Antibiotics can cause dangerous allergic reactions as well as produce resistance strains of bacteria, rendering many of our antibiotics useless for future infections. Early during my residency at Mount Sinai Medical Center, I studied research that showed that more people at high or moderate risk for SBE got sick and died from taking the antibiotics prior to dental treatment, than from SBE itself after having dental treatment without antibiotics.

The AHA recommendations have been under sharp scrutiny over the last few years, and an article in the November 1998 issue of the Annals of Internal Medicine by Brian L Strom, MD, MPH has cast even more doubt on the need for antibiotics prior to dental treatment. Recently, the AHA altered their recommendations, reducing both the amount of antibiotics required as well as the number of dental procedures it is required for. Now patients at high and moderate risk for SBE need only take antibiotics before their treatment. Adults should take 2 grams of amoxicillin 1 hour prior to dental treatment. Those adults allergic to penicillin or its derivatives should take 600 milligrams of clindamycin 1 hour prior to treatment. Erythromycin, which used to be the amoxicillin alternative and caused many patients upset stomachs and diarrhea, fortunately is no longer recommended.

Antibiotics are required prior to dental treatment that is expected to cause bleeding. The most common of those treatments include dental extractions, periodontal (gum) treatment, dental cleanings, placement of dental implants, and orthodontic bands for braces. Antibiotics are no longer required for dental fillings, crowning or capping of teeth, most anesthetic injections, removal of stitches, conservative root canal treatment, impressions, taking of x-rays, fluoride treatments, and polishing of the teeth.

Patients at risk for SBE can reduce their chances of getting this dangerous infection by seeing their dentist every 6 months and practicing good oral hygiene, brushing 3 times a day and flossing once a day. Your dentist may recommend you rinse with an in-office antiseptic mouth rinse prior to treatment (Peridex) if you have poor oral hygiene and are at high risk for SBE.