Antibiotic Premedication – A Necessity For Some

Posted by Dr. Edward Magida | Filed under , ,

A bacteremia is a medical term used to denote the buildup of certain types of bacteria in the bloodstream.

Bacteria get into the blood in a variety of ways. Cuts, abrasions, open sores and the like are obvious ways. Others are the simple acts of chewing, brushing your teeth and flossing. We've all been told about the myriad of germs always present in our mouths. These bacteria help produce decay, gum infections, and bad breath.

Dental treatment is another way to let bacteria into your bloodstream. The cleaning of teeth, restoration of cavities and the placement of crowns and bridges all cause the bacteria normally present in your mouth to get into your blood through you gums. There is no way to avoid traumatizing your gums during dental treatment.

Why is having bacteria in your bloodstream bad? In certain individuals, a condition called bacterial endocarditis can develop. It can be life threatening, but it is not common.

Even so, primary prevention of endocarditis whenever possible is important. Endocarditis usually develops in individuals with underlying cardiac defects. Blood borne bacteria may lodge on damaged or abnormal heart valves or near anatomic defects. It is not always possible to predict which patients will develop this infection or which procedure will be responsible.

Certain conditions are associated with endocarditis more than others. Individuals at highest risk are those who have prosthetic heart valves, a previous history of endocarditis, complex congenital heart disease or surgically constructed systemic pulmonary shunts or conduits. These high-risk patients are much more prone to develop an infection that can be fatal.

Individuals with the following conditions are considered to have moderate risk: patent ductus arteriosus, ventricular septal defect, primum atrial septal defect, coarctation of the aorta, and bicuspid aortic valve. Acquired valvar dysfunction due to rheumatic heart disease is also associated with a moderate risk.

Another condition, which might require antibiotics is mitral valve prolapse or MVP. The need for premedication before dental treatment for this condition is controversial, however. Some experts feel that only patients with valves that regurgitate, produce a turbulent blood flow, which would increase the likelihood of bacteria growing on the valve. If your doctor says you have mitral valve prolapse, it is important to find out if it is the kind that requires antibiotic premedication prior to dental treatment. Not all MVP needs premedication.

So what do we do to premedicate a susceptible person?

The incidence and magnitude of bacteremias of oral origin is directly proportional to the degree of oral inflammation and infection. Therefore, individuals who are at risk should maintain the best possible oral health to reduce the potential sources of bacterial infection.

Optimal oral health is maintained through regular professional care as well as immaculate home care.