An important finding in dentistry and medicine is that patients with periodontal (gum) disease have a higher incidence of heart attacks, high blood pressure and diabetes. All of the causes and effects are not fully understood but we know there is a systemic link in our bodies, when one area is under attack (infection) other areas can become adversely affected or vulnerable. We also know that the bacteria which normally live in the oral environment are not usually found in the blood stream. During certain dental procedures, i.e. when teeth are cleaned in the dental office, some of the oral bacteria get into the blood stream. The concern is that these oral bacteria may adversely affect a susceptible heart and some medical devices like artificial heart valves and total joint replacements. The areas that may be susceptible and patients who should be premedicated with antibiotics are those with:

• artificial heart valves
• a history of infective endocarditis (an infection of the lining inside the heart)
• certain congenital heart diseases
• total joint replacements early after surgery (i.e. hips and knees)

It is not unusual for a family member, friend and/or coworker to have been diagnosed with a heart murmur or treated for a painful joint with joint replacement. The array of treatment for heart and circulatory issues is ever widening and the treatment for joint replacement has grown as our population has aged and remained physically active. I am often asked about antibiotic premedication for joint replacement and heart murmur prior to dental appointments. The recommendations of the American Dental Association (ADA), the American Academy of Orthopedic Surgeons (AAOS) and the American Heart Association (AHA) regarding premedication of these conditions has evolved over the years and left many confused.

As recent as a few years ago it had been normal practice to premedicate patients with antibiotics prior to certain dental treatment to, in theory, prevent infection of the heart and certain medical devices like joints. After years of the medical and dental community dispensing antibiotics, there have been more antibiotic resistant strains of bacteria developing as well as severe allergic reactions to antibiotics. This has caused concern in the medical/dental community. The AHA, AAOS and the ADA have reviewed the literature and studies and concluded that the people who took antibiotic premedication in the past and no longer need premedication are:

• Mitral valve prolapse
• Rheumatic heart disease
• Bicuspid valve disease
• Calcified aortic stenosis
• Congenital heart conditions such as ventricular or atrial septal defect or hypertrophic cardiomyopathy
• Healthy total joint replacements after release of the orthopedic physician

It is always important to update your dentist and physician of your medical history and changes in medications. Stayed tuned and ask your physician, cardiologist, orthopedic surgeon and/or dentist if you have any questions.

Dr. Robert A. Gallegos is a Fellow in the Academy of General Dentistry, he is on the faculty of Spear Education, and a member of several dental organizations including the American Academy of Facial Esthetics, American Academy of Cosmetic Dentistry and the American Dental Association. Dr. Gallegos practices dentistry in Middleburg, VA. You can learn more about his practice at www.MiddleburgSmiles.com and request a copy of this article at info@middleburgsmiles.com.