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What Should I Know About Endocarditis, Antibiotics, and Dentistry

Bacterial endocarditis is an infection caused by bacteria that enter the bloodstream and settle in the heart lining or heart valves. Bacteria can enter the bloodstream in many ways. One common way is through infection of the gums or teeth (cavities). Poor dental hygiene in conjunction with inflamed, bleeding gums can greatly increase the risk for bacteremia (bacteria in the blood). Any professional dental treatment that causes bleeding – such as cleaning below the gum line, repairing or removing teeth – can also allow bacteria to enter the bloodstream.

Usually bacteria entering the bloodstream circulate through the body and are destroyed by normal body defenses. Sometimes, however, bacteria find a place to settle, and an infection starts. When the infection is in the heart, it is called endocarditis.

Children with congenital heart problems have a greater risk of developing endocarditis when bacteria enters the bloodstream. Endocarditis can seriously damage the heart. Therefore, Dr. Swati Singh or Dr. Sam Bullard may prescribe antibiotics as additional protection to help the child’s normal body defenses destroy bacteria before they can infect the heart.

Basic prevention can start at home with careful dental care. Anyone at risk for endocarditis should be especially careful about daily brushing and flossing to maintain healthy teeth and gums.

Antibiotics given immediately before teeth cleaning (or other procedures which may cause bacteremia) protect against infection. This is called SBE prophylaxis: protection against sub-acute bacterial endocarditis. Individuals at risk should receive this protection each time they have a procedure that increases their risk of bacteremia. The goal of antibiotic treatment is to provide short-term protection. Usually, one dose of antibiotic is given one hour before the procedure. This provides protection at the time it is needed, but limits the child’s exposure to antibiotics.

Cleaning of teeth below the gum line, tooth extraction, treatment of the vital nerve of the teeth and placement of orthodontic and appliance bands require premedication.

QUESTIONS PARENTS OFTEN ASK

Does my child need antibiotics when a “baby tooth” falls out?

No. Antibiotics are not necessary at these times.

My child is taking an antibiotic for an ear infection. Will that protect him/her?

No. Some bacteria may have developed resistance to that antibiotic. A different antibiotic should be used.

My child already takes antibiotic prophylaxis every day because he/she has no spleen. Will that protect him/her?

No. The normal body bacteria will have some resistance to that antibiotic.
A different antibiotic should be used.