Q: I have been diagnosed with a heart murmur. Do I need to take antibiotics when I get dental work?

A. In the past, patients with heart murmurs were advised to take prophylactic antibiotics prior to dental work to avoid infective endocarditis (IE), an infection of the heart's inner lining or the heart valves, but as of 2007 the American Heart Association (AHA) has revised these guidelines. Antibiotics are no longer recommended unless you have had a valve replaced, have a history of IE, or have another form of congenital heart defect.

Tooth brushing and flossing stimulate and release bacteria into the bloodstream. These bacteria then circulate throughout the body, including the heart. Healthy blood flow can normally clear any bacteria through the heart with no problem. However, this may vary for patients with a heart murmur.

A normal heartbeat is composed of two parts, which sound like “lub-dub” when using a stethoscope. Some adults and children, however, have an extra sound in their heartbeat. This is called a murmur. Heart murmurs can vary in sound and intensity and may be caused by a structural abnormality in the heart or some other condition. In general, they are harmless but some heart murmurs can indicate a more serious problem.

With a heart murmur, the flow of blood within the chambers of the heart is turbulent and may thicken or become stagnant. Without smooth flow through the heart’s chambers, your body may not be able to clear bacteria and normal daily infections as effectively. Patients with heart murmurs, then, do not have the same antibacterial properties to address bacteria in the bloodstream released during tooth cleaning and more vigorous dental work.

After lengthy studies, the AHA concluded that the risks of administering antibiotics, such as higher antibiotic resistance to certain strains of bacteria as well as potential allergic reactions, outweighed the benefits. In fact, the AHA recommends a good way to ensure heart health for patients with heart murmurs is to maintain excellent oral hygiene. These new guidelines may be confusing to patients and their families who have been taking preventative antibiotics. If you have questions or concerns, consult with your healthcare provider.

Nche Zama, MD, PhD, is a Board-certified cardiothoracic surgeon, Director of Cardiovascular and Thoracic Surgery at Pocono Medical Center, and Clinical Associate Professor of Surgery at the University of Pennsylvania.