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Q&A: Taking Antibiotics Prior to Dental Work When You Have a Heart Condition

Q: Do you have to take antibiotics whenever you have any dental work done if you have mitral valve prolapse? What about work such as scaling around the teeth; is anything that would make your gums bleed a risk?

A: It depends upon the type of mitral valve prolapse you have. The American Heart Association has published guidelines on this question. A person with mild prolapse who does not have a leaky valve (mitral regurgitation) and does not have any thickening of the mitral valve on echocardiogram does not need antibiotics prior to dental work. However, the presence of either a leaky valve or thickening of the valve leaflets is an indication to take antibiotics prior to any dental procedure, including routine cleaning by the dental hygienist.

Some experts are more cautious and recommend antibiotic prophylaxis for all dental work whenever the doctor can hear a “click” when listening to the heart, even if no murmur is heard.

For adults who are not allergic to penicillin or penicillin derivatives, the usual recommendation is 2 grams of amoxicillin taken by mouth one hour prior to dental work. There are a few alternatives for people who have a penicillin allergy.

 

Howard LeWine, M.D., is chief editor of Internet Publishing at Harvard Health Publications. He is recognized as an outstanding clinician and teacher and is a recipient of the Internal Medicine Teacher of the Year award at Brigham and Women's Hospital. Dr. LeWine continues to practice internal medicine; most recently he became a hospitalist after practicing primary care for more than 20 years.

 

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