Do you need antibiotics before dental work with mitral valve prolapse?
Up until about a decade ago, the answer would almost always have been yes. In the past, antibiotic prophylaxis before dental work was recommended for the majority of patients with mitral valve prolapse, but that is no longer the case.
Nowadays, medical professionals generally advise against antibiotics before dental treatment if you have the condition. Most doctors will only prescribe them if the patient is considered a high risk based on the latest medical guidelines regarding MVP and it is likely that the individual will benefit from taking the drugs before dental treatments.
Why is prophylaxis for dental procedures no longer recommended?
Doctors no longer recommend antibiotics (amoxicillin) before having work done on your teeth with MVP typically because the American Heart Association (AHA) no longer recommends it.
In 2007, they updated their guidelines concerning the use of antibiotic prophylaxis before dental work to prevent heart valve infections in patients with mitral valve prolapse.
The new guidelines, which were written with input from the American Dental Association, were quite controversial at the time, as the AHA had been recommending that most patients with MVP take antibiotics before certain dental procedures for years – since around the mid-1950s. All of sudden they were advising against it. A lot of patients had a hard time accepting this.
Similarly, physicians who had been advocating antibiotics before dental work with mitral valve prolapse had to suddenly alter their views and accept the new guidelines, which many found hard to do.
Why did the old MVP guidelines specify what they did?
The old guidelines specified what they did in an effort to prevent a serious infection of the heart lining and valves known as infective endocarditis, which is a complication of mitral valve prolapse.
The reason medical authorities believed this was appropriate is because minor studies looking at people with endocarditis infections in the past revealed that most patients had MVP. Also, many had undergone invasive medical or dental procedures like root canal treatments and tooth extractions.
What one needs to take into account is that such patients probably had a high degree of prolapse and/or thickened or leaking valves. When considering everyone with a mitral prolapse, only a tiny percentage of people might ever have developed endocarditis – less than 0.2 percent, it is reported.
In patients who have mitral valve prolapse that accompanies a murmur and mitral regurgitation (leakage), the infection rate increases slightly to about 0.5 percent, but in people who do not have regurgitating valves the rate of infection is similar that of the general population.
What it comes down to is that the old recommendations on antibiotics before dental work with mitral valve prolapse were not based on reliable, significant studies. Such studies would have been hard to conduct, given the low percentage of people who actually develop these infections.
Why did the guidelines on antibiotics before dental work change?
The guidelines changed because medical authorities realized that they needed revising. The old guidelines were introduced as a precautionary measure to attempt to prevent endocarditis infections, but they were not based on the findings of numerous controlled scientific studies.
There was no real evidence that taking antibiotic prophylaxis before dental treatment was beneficial in patients with MVP. Additionally, there wasn’t any proof that the drugs were not harmful, and there was a risk of serious side effects and reactions with the antibiotics. As can be expected, there were also concerns about the development of drug-resistant bacteria with these drugs.
Furthermore, it was more likely that someone with mitral valve prolapse would have been exposed to the bacteria that cause endocarditis through everyday activities such as food and gum chewing, tooth brushing, and flossing – activities that physicians were not prescribing the drugs for.
So who needs an amoxicillin dose before dental work with MVP?
Patients who are at highest risk of developing heart infections like infective endocarditis should take antibiotics before invasive medical and dental procedures, if prescribed by their doctor.
According to the updated AHA guidelines, MVP patients who have a history of endocarditis are among the highest risk patients. Those who have certain heart defects, a prosthetic heart valve, and/or have had valve repair with prosthetic materials also fall into the very “high risk” category.
While it is clear that people with mitral valve degeneration and/or regurgitation are more likely to develop endocarditis in some situations, the majority of doctors today will generally not prescribe antibiotics before dental work with mitral valve prolapse, as the risk of infection is minute.
The consequences of infection can be serious, though, and the antibiotics risk is small, so some physicians may continue to prescribe prophylaxis to patients with severe forms of MVP.
Should YOU take antibiotics before dental treatments?
This is something that you should discuss with your doctor.
If your physician doesn’t prescribe the drugs before dental treatments, he or she is likely acting in line with the latest recommendations by trusted medical authorities. If they do prescribe the drugs, this is probably because your risk of developing endocarditis is high and you might benefit from taking them.
Whatever the case, you should know exactly what the reasons are for their decisions and recommendations, as it can affect your well-being and MVP prognosis.
