Mitral Valve Prolapse: Dental Care and Endocarditis Prevention

Mitral valve prolapse, dental cleaning, prevention of endocarditis?

I have been diagnosed with mild mitral valve prolapse and experience symptoms such as chest pain and arrhythmia.
My primary physician mentioned that it is very mild, but I maintain a normal routine, and the symptoms persist.
The doctor advised regular follow-ups once a year.
I would like to ask:
1.
I have a dental issue and need to go for regular teeth cleaning.
Should I take prophylactic antibiotics? If so, what medication should I take and when? I asked my dentist, but they inquired when I would take the medication, which I am unsure about, so I am asking my physician.
2.
If the symptoms continue, should I seek a second opinion? Can traditional Chinese medicine help improve my condition? (I ask this because my primary physician only mentioned that it is very mild and that I should follow up once a year, which makes me feel that my condition is being taken lightly and I do not fully understand my health status.)

FORRA, 30~39 year old female. Ask Date: 2020/06/07

Dr. Wu Xueming reply Cardiology

Patients with mitral regurgitation are at an increased risk of bacteremia, which can lead to bacterial endocarditis, especially when undergoing procedures that may cause bleeding.
Therefore, prior to dental procedures such as teeth cleaning, tooth extraction, or dental implants, as well as other invasive procedures like lithotripsy for urinary stones or polypectomy, it is recommended to take prophylactic antibiotics one to two hours before the procedure.
After the treatment, a course of antibiotics may also be necessary, depending on the situation, to prevent the occurrence of bacterial endocarditis.
For most patients with mild mitral valve prolapse, physicians typically recommend lifestyle modifications, such as avoiding stimulants like strong tea and coffee that can increase heart rate, ensuring adequate sleep, managing stress, and engaging in moderate exercise to help alleviate symptoms.
Regular follow-up visits to a cardiologist every few years, with echocardiograms as needed, are also advised.

Reply Date: 2020/06/07

More Info

Mitral Valve Prolapse (MVP) is a condition where the mitral valve does not close properly, which can lead to various symptoms, including chest pain and arrhythmias. Your concerns about dental care and the risk of infective endocarditis are valid, especially given your diagnosis.
1. Antibiotic Prophylaxis for Dental Procedures: For patients with MVP, especially those with associated symptoms or other risk factors, the need for prophylactic antibiotics before dental procedures, such as teeth cleaning, is a common concern. The American Heart Association (AHA) guidelines suggest that antibiotic prophylaxis is generally recommended for patients with a history of infective endocarditis, prosthetic heart valves, or certain congenital heart conditions. However, for most patients with mild MVP without significant regurgitation or other complications, prophylactic antibiotics may not be necessary for routine dental procedures, including cleanings.
If your dentist is unsure about the need for antibiotics, it is essential to communicate your condition clearly. Typically, if antibiotics are indicated, amoxicillin is the drug of choice, and the standard dose is 2 grams taken orally about one hour before the procedure. If you are allergic to penicillin, alternatives such as clindamycin or azithromycin may be prescribed.
2. Ongoing Symptoms and Further Evaluation: If you continue to experience symptoms such as chest pain and arrhythmias, it is crucial to follow up with your healthcare provider. While your cardiologist may have deemed your MVP as "mild" and suggested annual follow-ups, persistent symptoms warrant further investigation. It may be beneficial to seek a second opinion or consult a different cardiologist to ensure that your condition is being managed appropriately.
Additionally, exploring complementary therapies, such as Traditional Chinese Medicine (TCM), may provide some relief for your symptoms. However, it is essential to discuss any alternative treatments with your primary healthcare provider to ensure they do not interfere with your current treatment plan.

In summary, while routine dental care for patients with mild MVP typically does not require antibiotic prophylaxis, it is crucial to communicate your condition to your dentist and follow up on any persistent symptoms with your healthcare provider. Regular monitoring and a proactive approach to your health can help manage your condition effectively. Always prioritize open communication with your healthcare team to ensure you receive the best care tailored to your needs.

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