Questions posted in the
Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.
| |
|
Subject: Re: Antibiotic treatment for dental work I have cardiomyopathy from chemotherapy (Adriamycin). I have 50% EF and mild MVP. I will soon undergo dental work to fill some cavities. I understand that I have to have an antibiotic treatment before. My dentist's opinion is that antibiotics will cause allergic side effects and future resistance to antibiotics. In my case, do you think it is necessary to take antibiotics for my dental work? If I don't take antibiotics, what are the dangers for me? Do you have any suggestions? Thank you. Your forum is a great help to me.
________ Dear Kim, thank you for your question. The issue of antibiotic prophylaxis for dental procedures for people with valvular heart disease is controversial. Your dentist is correct in that indiscriminate use of antibiotics can cause side effects and can induce resistance in common infectious organisms. On the other hand, endocarditis can be a serious disease that should be prevented if at all possible. The American Heart Association has published official guidelines on this subject and antibiotics are not recommended for mitral valve prolapse without mitral valve regurgitation. What this means is that with MVP, the mitral valve tends to "dome" into the left ventricle during the systolic phase of the cardiac cycle while it is closed. The mitral valve domes because the leaflets are slightly enlarged and are more compliant than usual. Mitral regurgitation (MR) can result when the leaflet tips do not coapt completely which allows blood to leak back into the left atrium through the mitral valve. Bacteria that normally live in the gums and the oral cavity can enter the bloodstream during dental procedures. These bacteria can colonize an abnormal cardiac valve to caused endocarditis, but the valve usually has to be leaking or be stenotic for this to happen. If you don't have MR with the MVP, then your risk of endocarditis would be low. However, even with a low risk, there's still a finite possibility of contracting endocarditis with MVP. Thus, the official guidelines do not recommend endocarditis for lone MVP, but I'm not sure if you have MR with the MVP or not. Thus, you should speak with your physician regarding this topic. It would be a good idea to review an echocardiogram (if one has been done to diagnose the MVP) to determine whether or not you have MR. Then, your physician could speak with your dentist, and together with your input, they could formulate a plan. Other users of the heart forum have written in with their personal stories of endocarditis caused by dental procedures without prophylaxis, but you should not use those stories as justification that you definitely need antibiotic prophylaxis. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem. | |
