HEALTH MATTERS: Benefit of antibiotics before teeth cleaning usually isn’t worth the risk

Q. I have mitral valve prolapse and for years I was instructed to take antibiotics prior to dental procedures like teeth cleaning. I recently saw my dentist and she told me that antibiotics are no longer required. I’m confused.

A. No wonder. The confusion is the result of a recent change in our official recommendations.

Here’s the background: For years, we recommended that people who have various kinds of heart murmurs take antibiotics before dental and certain surgical procedures to reduce the risk of bacteria (“bugs”) being introduced into the body by the procedure, infecting the heart valve and damaging it.

Your condition of mitral valve prolapse, for example, is one where the mitral valve (one of the four valves in the heart that regulates the flow of blood through the heart) is abnormally thickened. The thickening of the valve makes it more susceptible to infection; hence the recommendations to take antibiotics. But our prior antibiotic recommendations never were based on good scientific evidence showing that they really worked; the recommendations were made because they made sense.

As we’ve seen more bacteria become resistant to antibiotics because their use has skyrocketed, we’ve reconsidered the value of antibiotics in conditions like yours. The newest guidelines, released just a few years ago, recommend antibiotics before procedures in only four settings:

n In patients with heart valve replacement.

n In patients who have had a previous infection of their heart valve.

n In heart transplant recipients.

n In some patients with congenital heart ailments (such as holes in the heart).

However, these four settings actually are rather rare and most patients with heart murmurs (a sound we can hear with the stethoscope applied to the chest that is due to leaking or narrowing of one or more valves) no longer qualify for antibiotics.

The possible benefit of antibiotics prior to procedures for patients without the four conditions mentioned above just isn’t worth the risk of producing even more antibiotic-resistant bugs. So have little concern — your dentist gave you the latest and best advice now available. If you still feel uncomfortable about the advice, speak with your health care provider.

Q. What are the common causes of swollen ankles? My ankles puff up like balloons at the end of the day or after a long airline flight. Do you think that I have a heart problem?

A. Probably not. While heart failure (reduced pumping action of the heart) can cause ankle swelling (we call it “edema”), it is usually a sign that we see late in the course of a heart condition.

Because you don’t mention a heart problem, I’ll bet that your edema is not due to your heart. The most common cause of ankle swelling is due to problems with the veins in the legs. Veins bring the blood back to the heart from the legs, but as they age, they become more lax and don’t function as well.

Blood is made up of fluid and various cells (along with some other components that aren’t relevant to our discussion). The fluid component leaks out of the lax veins and causes the swelling, while the cells are too large to leak out and they stay inside the veins. Treatment for most leg edema is elevation of the legs, compressive stockings and diuretics (water pills) in some cases. Mention your edema to your health care provider, but I’ll bet your problem is in the veins and not your heart.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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