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Oral Surgery And Heart Murmurs


oral-surgery-fears-300x199Have you ever wondered why a dentist or oral surgeon wants a complete record of your medical history? There is a very good reason they need this information. If you are pregnant, they need to know before they take any x-rays. If you have back injuries, they need to know before they lean you back in the dental chair. If you have a heart murmur, they might give you antibiotics to take before they do any procedures.

What Is A Heart Murmur?

A heart murmur is a heart valve condition where the value does not close properly or there is some type of blood leaking around the heart. There are several types of heart murmurs and different causes ranging from mild to more severe; you should talk to your doctor to determine if you have a heart murmur and if it is problematic.

Heart murmurs are common in children, but generally, as they grow to adulthood, the murmur stops. However, some children do have congenital heart murmurs that last throughout their lives. In adults, the murmur can be caused by an overworked heart valve or a hole in the wall of the heart. It can also be caused by narrowing blood vessels in the heart.

If the valve is small, forcing the blood into the heart the murmur is called stenosis. If the valve is defective and leaks, it is called regurgitation. Other problems that cause heart murmurs are rheumatic fever, coronary artery disease and infective endocarditis or aging.

There are conditions that cause heart murmurs such as pregnancy or high blood pressure. Even thyroid problems can cause heart murmurs from time to time. Many people with heart murmurs but may not be aware of it, until a doctor with a trained ear hears it during a routine examination. Most are innocent and will not cause any heart problems, but if there are additional issues with your heart, your doctor can run tests that are more extensive.

Will I Need Antibiotics Before Any Dental Surgery?

No one goes to the dentist to have their heart checked, but why do they ask about heart murmurs? The dentist or oral surgeon is not worried that you will have a heart attack or other heart related issue while visiting them. Dental procedures are no longer the terrifying experience they once were. A heart murmur is a concern before any oral surgery because of infection.

Many dentist and oral surgeons find it prudent to give their patients an antibiotic prior to any invasive procedure, like tooth extraction or root canal, to reduce the risk of infection caused by bacteria that can infect the heart valve and lining of the heart.

Infective endocarditis (IE) is an infection that can affect people with heart valve problems since the blood does not travel properly through the heart. If the bacteria from an infected tooth is introduced into the body during the surgery, the bloodstream will carry the bacteria to the heart, where it will stick to the heart valve or the lining of the heart. This is called bacterial endocarditis (BE). Bacterial endocarditis can cause very serious problems if it enters the heart including heart failure or more heart valve leakage.

Some studies show antibiotics prior to oral surgery are very helpful in controlling infective endocarditis. At the same time, other studies indicate antibiotics were not important to use. In 2008, the National Institute of Health and Clinical Excellence (NICE) changed their guidelines, preventative antibiotics are not necessary for anyone. This is something you will need to discuss with your dentist or oral surgeon before having any procedure done.

Not only will your dentist or oral surgeon discuss their experience with or without the use of antibiotics prior to invasive surgery, but they will want to know the details of your heart murmur and what is causing it. Some conditions present more of a risk than others do.

How Many Antibiotics Will I need?

Generally, your dentist or oral surgeon will prescribe an antibiotic tablet to be taken about one hour before the procedure is started. If you are unable to swallow pills, an antibiotic injection can be given about 30 minutes prior to the procedure. They may prescribe additional antibiotics to be taken after the procedure, but that is common with all surgeries and is not specific to people with a heart murmur.

What Are The Risk Factors?

People with the highest risk of developing bacterial endocarditis are those suffering from:

•A prosthetic heart valve

•Prior history of infective endocarditis

•Various forms of congenital heart abnormalities

There are many other causes of heart murmurs, but they are considered by the American Heart Association to carry a much lower risk of infective endocarditis and may not require the use of antibiotics prior to a dental procedure.

What Are Signs Of Infection?

Call your doctor if you have any of the following signs of infection:

•Fever over 100º

•Sweats or chills

•Skin rash

•Cut or wound that will not heal

•Sore throat or pain when swallowing

•Sinus drainage

•Persistent dry or moist cough

•White patches in your mouth or on your tongue

What Effects Can Heart Murmurs Have On Oral Health?

According to the Mayo Clinic, people with heart murmurs caused by the conditions above or others who are subject to infection with heart related complications should practice good oral hygiene, as bacteria from plaque, gingivitis and periodontal disease could lead to bacterial endocarditis. Humans are covered with bacteria, and not all strains cause endocarditis. However, if you are at risk for bacterial endocarditis, you need to take extra precautions to reduce the possibility of contacting it.

Good oral health is important for everyone, but anyone with an elevated risk factor due to heart murmurs needs to pay close attention to brushing and flossing every day. Keep regular check-ups with your dentist. If oral problems do appear, have them treated immediately to reduce the amount of bacteria in your bloodstream. Discuss any concerns you have with your doctor, dentist, and oral surgeon.

If you have any questions about our procedures or would like to schedule an appointment, contact Austin Oral Surgery today.