I graduated Columbia’s School of Dental & Oral Surgery in 1994. At the time, the consensus recommendation established by the medical community was such that, “anyone who had a heart murmur should be premedicated prior to their dental visit, for life!”
As a matter of fact, the accepted protocol for dental premedication was a whopping mouthful—- 3.0 grams (6 x 500 milligrams pills) one hour prior to a dental appointment and then 1.5 grams (3 x 500 milligrams) eight hours after the initial dose. To say nothing of the stomach upset………
Why should I premedicate? What is the thought behind premedication?
The thought behind premedication is based on transmission of bacteria. By the same token, transplanted bacteria from the mouth can act as a source of infection in another part of the body. Moreover, a simple local anesthetic needle puncture in the mouth can transport it from the cesspool of the mouth into the patient’s bloodstream. This bacterium, transported mechanically, would then be free to stroll the corridors of blood vessels. It can then nefariously deposit itself onto an already troubled heart valve or bionic prosthetic joint. To that end, it “sets up shop” and initiates a destructive process of tissue destruction. Subsequently, the patient can incur a shredded heart valve or a diseased prosthetic joint. Antibiotic premedication blasts those pesky bacterium dead. Essentially, the antibiotic blast creates a temporary sterile environment. Therefore, premedication offers a lesser potential for tissue damage.
Then and Now…….
The literature is all over the place.
ANTIBIOTIC PROPHYLAXIS IS RECOMMENDED FOR A SMALL NUMBER OF PEOPLE WHO HAVE SPECIFIC HEART CONDITIONS. THE AMERICAN HEART ASSOCIATION HAS GUIDELINES IDENTIFYING PEOPLE WHO SHOULD TAKE ANTIBIOTICS PRIOR TO DENTAL CARE. ACCORDING TO THESE GUIDELINES, ANTIBIOTIC PROPHYLAXIS SHOULD BE CONSIDERED FOR PEOPLE WITH:
- Artificial heart valves.
- A history of an infection of the lining of the heart or heart valves known as infective endocarditis, an uncommon but life-threatening infection.
- A heart transplant in which a problem develops with one of the valves inside the heart.
- Heart conditions that are present from birth, such as:
- Unrepaired cyanotic congenital heart disease, including people with palliative shunts and conduit.
- Defects repaired with a prosthetic material or device—whether placed by surgery or catheter intervention—during the first six months after repair.
- Cases in which a heart defect has been repaired, but a residual defect remains at the site or adjacent to the site of the prosthetic patch or prosthetic device used for the repair.
IN ADDITION, ARTIFICIAL JOINT REPLACEMENT PREMEDICATION PROTOCOL IS JUST AS AMBIGUOUS. YOU CAN FIND CONFLICTING LITERATURE ALL OVER THE WEB. IT’S BEST TO SPEAK TO YOUR ORTHOPEDIC DOCTOR FOR CLARITY ON THEIR PERSONAL GUIDELINES.
I have my own opinions about premedication. I look forward to expanding on my ideas on my upcoming video release this weekend on my You Tube Channel. Stay tuned :
You Tube Channel. Robert Emilio DDS & Associates
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