Tooth Extraction and Mitral Valve Prolapse: What You Need to Know

Q: Tooth Extraction and Mitral Valve Prolapse: What You Need to Know

Hello： According to the American Heart Association's guidelines on the prophylactic use of antibiotics for the prevention of heart disease published in 1997, patients with mitral valve prolapse who have associated regurgitation need to take antibiotics prior to certain dental pro

Tooth extraction vs. mitral valve prolapse!?

Hello Doctor: I was recently diagnosed with mitral valve prolapse and some regurgitation, which I don't quite understand.
The doctor advised me to be cautious about bacterial endocarditis when undergoing tooth extraction or dental cleaning.
I would like to ask if I need to inform the dentist before or after the treatment.
Is it necessary to go to a major hospital for dental care due to my heart condition, or can I go to a regular clinic? I have a wisdom tooth that has been impacted in my gums for a long time, and it has been painful for several days, with my gums starting to swell, which makes me hesitant to see a dentist! If I get infected, could it be serious? If I need to have a tooth extraction, what special precautions should I take?

Joyce, 20~29 year old female. Ask Date: 2003/08/26

Dr. Liu Tiancai reply Dentistry

Hello: According to the American Heart Association's guidelines on the prophylactic use of antibiotics for the prevention of heart disease published in 1997, patients with mitral valve prolapse who have associated regurgitation need to take antibiotics prior to certain dental procedures to prevent bacterial endocarditis; however, not all dental treatments require prophylactic antibiotics.

1.
Dental procedures that require prophylactic antibiotic administration include:
1.
Tooth extraction
2.
Periodontal surgery
3.
Dental cleaning
4.
Root planing
5.
Periodontal probing
6.
Dental implants
7.
Re-implantation of teeth
8.
Surgical root canal treatment beyond the apex
9.
Subgingival antibiotic treatment
10.
Certain orthodontic procedures.

Essentially, any procedure that may cause bleeding or create an open wound necessitates prophylactic antibiotics.
2.
Dental procedures that do not require prophylactic antibiotic administration include:
1.
Dental fillings
2.
Denture fabrication
3.
Local anesthesia in dentistry
4.
Root canal treatment within the root canal
5.
Use of rubber dams
6.
Suture removal
7.
Fabrication and placement of removable dentures
8.
Impressions
9.
Dental X-rays
10.
Extraction of loose primary teeth.
Regarding Joyce's situation, it is essential to inform the dentist about your heart condition prior to dental treatment so that the dentist can prescribe prophylactic antibiotics.
Generally, the recommended method for prophylactic antibiotic use is to take 2 grams of penicillin one hour before the procedure (unless there is a drug allergy).
Therefore, if you mention it afterward, it will be too late.
Receiving dental treatment at a major hospital is a safer option for patients with heart disease.
Joyce should find time to have her impacted wisdom tooth extracted at the hospital to prevent infection.
With the correct use of prophylactic antibiotics, some patients with heart disease can safely undergo dental treatment.
Best wishes for your health,
Dr.
Liu Tian-Cai, Director of Dentistry, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2003/08/26

More Info

When it comes to dental procedures such as tooth extractions, individuals with mitral valve prolapse (MVP) or any heart condition must take special precautions to prevent potential complications, including infective endocarditis. Infective endocarditis is an infection of the inner lining of the heart, which can occur when bacteria enter the bloodstream during dental procedures.
First and foremost, it is crucial to inform your dentist about your diagnosis of mitral valve prolapse and any other heart conditions before undergoing any dental treatment. This information allows the dentist to take necessary precautions, such as prescribing prophylactic antibiotics before the procedure to minimize the risk of bacterial infection. Typically, the American Heart Association recommends antibiotic prophylaxis for patients with certain heart conditions undergoing invasive dental procedures, including tooth extractions.
Regarding your question about whether to inform the dentist before or after the procedure, it is imperative to disclose this information beforehand. This ensures that the dental team can adequately prepare for your treatment and implement any necessary precautions to protect your heart health.

As for the choice of dental facility, while many general dental practices are equipped to handle patients with MVP, it may be advisable to consult with a dentist who has experience treating patients with heart conditions. In some cases, particularly if your condition is more complex or if you have other underlying health issues, a referral to a dental specialist or a hospital-based dental clinic may be warranted. These facilities often have the resources and expertise to manage patients with significant medical histories.

Regarding your impacted wisdom tooth, it is understandable to feel apprehensive about seeking treatment, especially with the fear of infection. However, it is essential to address the issue promptly, as an untreated impacted tooth can lead to further complications, including infection, abscess formation, and pain. If you are experiencing swelling and pain, it is a sign that you should seek dental care as soon as possible.
When preparing for a tooth extraction, especially with your medical history, here are some important considerations:
1. Preoperative Assessment: Ensure that your dentist is aware of your medical history, including any medications you are taking, particularly anticoagulants or other heart-related medications.

2. Antibiotic Prophylaxis: Discuss with your dentist whether you need antibiotics before the extraction to prevent infective endocarditis.

3. Postoperative Care: Follow your dentist's instructions carefully after the extraction. This may include taking prescribed medications, managing pain, and monitoring for any signs of infection, such as increased swelling, redness, or discharge.

4. Follow-Up Appointments: Schedule follow-up visits to ensure that the extraction site is healing properly and to address any concerns that may arise.

5. Emergency Plan: Know what to do in case of an emergency, such as severe pain or signs of infection, and have a plan for contacting your healthcare provider.

In summary, while having mitral valve prolapse does require additional precautions when undergoing dental procedures, with proper communication and planning, you can safely receive the dental care you need. Do not delay seeking treatment for your impacted wisdom tooth, as timely intervention can prevent more serious complications.

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