I find much satisfaction in extracting the wisdom teeth of high school students. At first glance, the procedure appears tedious because the whole tooth is imbedded in the mandible, but they could be extracted rather easily because the roots are not fully developed yet.
I removed my first son’s wisdom teeth a few years ago. He was a strong, healthy child on the tennis team but he had to take 2.0 g of Amoxicillin one hour before because he had a mild MVP (mitral valve prolapse).
In order to join the tennis team, my son Mark underwent a physical exam, and we found out that his heart was slightly enlarged. A cardiologist examined him and diagnosed that he had a minor abnormality with his heart valve. This caused some blood to leak through the valve with each pump. No surgery or treatment was required, but I was advised to give him prophylactic antibiotics preceding dental operations.
I tried to call and remind my patients who have heart problem to take antibiotics prescribed before they come to my office. We know how patients used to have be rescheduled even after they took the day off from work because they didn’t remember to take their pre-medication.
There is good news; the American Heart Association(AHA) published a new guideline this past April 2007 revealing that it is unnecessary for the patients to take short-term antibiotics before dental treatments. For decades, the AHA advised patients with certain heart conditions to take the antibiotics believing it would help prevent infective endocarditis (IE). IE is an infection of the heart’s inner lining or valve, which results when bacteria enter the bloodstream and travel to the heart.
The guidelines are based on a growing body of scientific evidence that shows that the risks of taking preventive antibiotics outweigh the benefits for most patients. Inappropriate use of antibiotics can lead to the development of drug-resistant bacteria.
Their hearts already are exposed to bacteria from the mouth that can enter their bloodstreams during basic daily activities such as brushing or flossing. The most recent comprehensive studies show that IE is more likely to occur as a result of these everyday activities than from a dental procedure.
Preventive antibiotics before a dental procedure are advised for patients with certain specific serious congenital heart conditions, artificial heart valves, cardiac transplantation. Patients and their families should ask their health care providers careful questions anytime antibiotics are suggested before a medical or dental procedure.
The AHA guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.
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