Dental Procedures & Heart Operations

There is a very common question that many patients who had cardiac surgery are faced with, every time thy visit their dentist : “do I need to have/give antibiotics before dental procedures?”

Experts around the world, including heart specialists in Europe and North America, agree that some patients are at higher risk of developing a serious heart infection called  infective endocarditis. For these higher-risk patients, especially those with certain heart conditions or valve problems, the risk of getting this infection during dental procedures is greater than the risk of side effects from antibiotics. Because of this, doctors may recommend taking a preventive (prophylactic) antibiotic before certain dental treatments to help protect your heart.

In the absence of clear evidence either for or against antibiotic prophylaxis, it is probably reasonable to recommend prophylactic antibiotic before dental procedures that involves manipulation of gingival tissue, manipulation of the peri-apical region of teeth  or perforation of the oral mucosa in patients with valvular heart disease  (patients with a previous history of IE, prosthetic heart valve-rings-chords-clips or valve repaired with prosthetic material, not repaired cyanotic congenital heart disease, or certain repaired congenital heart defects and cardiac transplant with valve regurgitation) and probably aortic prosthetic graft material.

If you need antibiotics before your dental procedure, your doctor or dentist may recommend a single dose taken 30–60 minutes beforehand. In the UK, one option is ato use sachet of sugar-free Amoxicillin powder, which is mixed with water and taken by mouth. This is commonly used and works well. If you are allergic to Penicillin, there are other safe antibiotic options and you dentist will advice you accordingly (detailed advice on the table bellow). 

 In July 2016 NICE (UK) made a small but extremely important change to Clinical Guideline 64 (CG64), Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures – Recommendation 1.1.3, ‘Antibiotic prophylaxis against infective endocarditis is not recommended for people undergoing dental procedures’ (or other non-dental procedures) has now been changed to ‘Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.’ This change was precipitated by publications stating that it is inappropriate to withhold antibiotic prophylaxis from patients at high-risk of developing infective endocarditis, particularly in light of a recent change in the law concerning informed consent.

The change in wording now allows clinicians to comply with the new GMC recommendation on consent which states that ‘Doctors and dentists should offer the most appropriate treatment options, in consultation with the patient and/or their carer or guardian. In doing so, they should take account of the recommendations in this guideline and the values and preferences of patients and apply their clinical judgment’. These changes have made it necessary for dentists to explain to their patients the differences between NICE recommendations and recommendations from other guidelines with regards to the use of antibiotic prophylaxis during dental work.

When a patient has undergone a heart operation involving prosthetic material, they are considered to be at higher risk of developing infective endocarditis. This includes patients with a history of previous endocarditis, a prosthetic heart valve or valve repair using prosthetic material, unrepaired cyanotic congenital heart disease, or certain repaired congenital heart defects. In these situations, it is important that patients are appropriately counselled about this risk. As part of this, it is recommended that they are advised and consented for the use of prophylactic antibiotics before certain dental procedures, in line with current clinical guidance, to help reduce the risk of infection.