Antibiotics guidelines revised for dental work.

Far fewer people need preventive antibiotics before dental procedures than previously recommended, maintains a disease specialist at the Mayo Clinic, Rochester, Minn.

The use of preventive antibiotics for people with certain heart conditions stems from worries about endocarditis. That condition is an infection of the thin membrane that lines the chambers and valves inside the heart, called the endocardium. Endocarditis occurs when bacteria or germs from another part of the body, such as the mouth, enter the bloodstream and travel to the heart and attach to abnormal heart valves or damaged heart tissue.

A committee of the American Heart Association, Dallas, Tex., found that, for most people, the risk of endocarditis from dental complications is low. Daily activities, such as brushing, flossing, or chewing, are much more likely to cause endocarditis than are bacteria that enter the bloodstream from a single dental procedure. "Preventive antibiotics before dental work are now recommended only for people who, if they develop endocarditis, are more likely to die or have serious complications," says Walter Wilson, an infectious disease specialist at the Mayo Clinic who headed the AHA committee that recently revised the association's guidelines.

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The new recommendations suggest preventive antibiotics before dental work only for those with artificial heart valves, a history of infective endocarditis, certain forms of congenital heart disease, and cardiac valve abnormalities following a heart transplant. Preventive antibiotics no longer are recommended for many people who have common heart conditions such as mitral valve prolapse or rheumatic heart disease.

Before their next dental visit, patients who have taken preventive antibiotics should check with a doctor or dentist to discuss the guideline changes and determine if the medication is necessary.