by Jeff Vidrine

Created on: July 03, 2007

The first writer, in response to this question, provided a good summation about this medical condition, its diagnosis and treatment. Both writers touched upon the connection between SBE and dental treatment. However, in April 2007, the American Heart Association issued new guidelines for the prophylaxis for infective endocarditis which is the new term used for SBE.

In Circulation, the journal of the American Heart Association, the new guidelines call for a greatly reduced use of preoperative antibiotics to prevent infective endocarditis. Patients who previously were required to take antibiotics before dental procedures are now exempt under the new guidelines. These include people with:
-mitral valve prolapse
-rheumatic heart disease
-bicuspid valve disease
-calcified aortic stenosis
-congenital heart conditions.

Only those patients at greatest risk for getting infective endocarditis need take the antibiotic regimen preoperatively. The American Heart Association defines these patients as those with:
-artificial heart valves
-a history of infective endocarditis
-certain specific, serious congenital (present from birth) heart condition
-any repaired congenital heart defect with residual defect
-a cardiac transplant that develops a problem in a heart valve.

The new recommendations apply to dental procedures such as extraction, deep cleaning, and many other dental procedures. The reasoning behind the change is twofold. First, oral flora are daily introduced into one's bloodstream by normal, everyday activities such as brushing and flossing. Secondly, there is scientific research that shows a much higher incidence of allergic reaction to the antibiotic, to include anaphylaxis which can be fatal than the incidence of infective endocarditits. There is also evidence that the multi-drug resistant bacteria that medicine is now facing is due to the high use of antibiotics.

One may find more information, including the complete report of the American heart Association, at www.ada.org. In summary, SBE, now called infective endocarditis, is an often fatal infection of the heart. Most of the conditions that dentists used to prescribe antibiotics prophylactically have been removed from the list, leaving only five conditions which would require prophylaxis. If one had one of these conditions, the treating cardiologist would be the ultimate decision maker on the choice to use antibiotics or not.

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