New Pre-Med Guidelines


In April, the American Heart Association, along with the ADA released new guidelines for antibiotic premedication of patients with certain heart conditions. The new guidelines do not include any changes in premedication for those patients with artificial joint replacement.

According to the ADA’s statement, these patients no longer need pre-med:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy

The ADA says patients with the following conditions DO need to pre-medicate:

  • artificial heart valves
  • a history of infective endocarditis
  • certain specific, serious congenital (present from birth) heart conditions
  • a cardiac transplant that develops a problem in a heart valve

It is imperative that you, as a dental health professional carefully read the ADA‘s statement. In addition, please read Dr. Michael Rethman’s article in the May issue of Dimensions of Dental Hygiene. Dr. Rethman makes a great point when he says “it’s possible that the dentist or hygienist may have an incomplete medical history” and that “a patient’s physician may still recommend antibiotic premedication based on older recommendations”. In a nutshell, there may be situations that warrant continued antibiotic coverage. When in doubt, check with the patient’s physician.

Here are links for both articles:

ADA Statement

“New Guidelines for Antibiotic Premedication” by Dr. Rethman

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