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Dental Standard of Care Requires Use of Antibiotics to Protect Heart Patients

Changes in the American Heart Association Guidelines may impact the use of antibiotics by dentists during tooth extractions and root canal treatment. The impetus for the new guidelines appears to be concern for prophylactic use of antibiotics when the are not indicated, which can lead to treatment resistant infections down the road. However, the standard of care, i.e., what a reasonably prudent dentist would do under like or similar circumstances, does require the use of antibiotics by dentists in a number of important situations in order to avoid catastrophic results. One such use involves protection of the heart from infection due to tooth extraction or root canal therapy. Infective endocarditis is a bacterial infection of the heart lining, heart valve or blood vessel. Although rare, it can occur when bacteria enter the bloodstream through breaks in the gums during invasive dental procedures or oral surgery. It can cause serious injury or even death if untreated. A common group of bacteria that cause this infection is Viridans Group Streptococci  or VGS. Importantly, dental patients with existing heart conditions, including those with prosthetic heart valves, are more susceptible to the infection, while dental patients with normal heart valves develop the infection less often.

In 2007, the American Heart Association changed its guidelines, recommending patients take antibiotics before invasive dental procedures only if they are at risk of complications from infective endocarditis. This includes patients with artificial heart valves, transplanted hearts with abnormal heart valve function, previous infective endocarditis and people born with heart defects. However, the guidelines were careful to note that the giving of preventative antibiotic treatment should be limited when not indicated, as noted above. Dental patients should ask their primary care doctor or cardiologist if there is any question at all as to whether they should continue to take preventive antibiotics based on the new guidelines. Patients and their families should ask careful questions of their doctors and dentists anytime antibiotics are suggested before a medical or dental procedure. Similarly, if they are aware of a condition that they have that requires the use of antibiotics prior to dental treatment, they should be careful to note that on the dental office intake forms and to bring this to the attention of their dentist or oral surgeon.

They should also be aware that overuse of antibiotics when they are not indicated, can lead to a worse outcome than if they were not used at all. Because of the overuse of antibiotics, there has been an increase in the number of antibiotic resistant bacteria. When this happens, new and much more complex antibiotics must be created to kill these new bacteria. The new bacteria are typically more severe and can cause more serious illnesses.

Attorney Robert J. Fleming has been handling wrongful death cases, automobile accident cases, personal injury cases, dental malpractice and medical malpractice lawsuits for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of another for more than 20 years in and around Atlanta, Georgia and its surrounding areas, including Alpharetta, Austell, Avondale Estates, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have been seriously injured and would like quality legal representation, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.