Change in Antibiotic Prophylaxis recommendations

The American Heart Association has updated its guidelines for the first time in ten years and no longer considers antibiotic prophylaxis the best way to prevent infective endocarditis in dental patients.  Patients with artificial heart valves, a past history of endocarditis, heart transplants, or certain congenital defects will still need premedication.  Premedication is no longer recommended for mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, or congenital heart conditions such as ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy.   Patients who previously premedicated are asked to contact their cardiologists for re-evaluation.

"A comprehensive review of published studies that suggest Infective Endocarditis is more likely to occur from bacteria entering the bloodstream as a result of everyday activities than from a dental procedure," the release said.

Maintaining a high level of daily oral hygiene and a regular schedule of dental visits will best preserve the health of your gum tissues, minimizing the ingress of bacteria into your bloodstream.

For further information on this topic:
http://ada.org/public/topics/antibiotics.asp

Bisphosphonates

Oral bisphosphonates: Fosamax, Actonel, Boniva, Skelid, Didronel-- usually prescribed in the treatment of osteoporosis.

Intravenous bisphosphonates:  Aredia, Zometa, Bonefos-- usually prescribed in the treatment of hypercalcemia, multiple myeloma, breast, lung and other cancers, and Paget's disease of the bone.

Reports of osteonecrosis of the jaw have been reported in some patients on bisphosphonate therapy.  There appears to be a closer association between intravenous drug therapy and this condition as compared with oral drug therapy.  Typical symptoms include pain, swelling, infection, loose teeth, drainage, and exposed bone.  Patients on oral medication as treatment for osteoporosis appear to be at much lower risk than patients on intravenous therapy.

A recent position paper by the American Association of Oral and Maxillofacial Surgeons makes the following recommendations:

• A comprehensive oral evaluation for all patients about to begin therapy with oral bisphosphonates.  Optimal dental health should be attained.
• Patients must maintain good oral hygiene, have regular dental evaluations, and immediately report any pain, swellling, or exposed bone.
• Patients with full or partial dentures should be examined regularly for any denture sores or exposed bone.