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Is it true that I need antibiotics prior to dental work if I have Mitral Valve Prolapse?

I am asked practically every week if someone who has Mitral Valve Prolapse (MVP) needs antibiotics prior to going to the dentist. The short answer is probably not, but I will dive into the topic and give you the facts.

First let me explain a little about MVP. Mitral Valve Prolapse (MVP) means that one or both of the leaflets of the mitral valve “billows” into the left atrium, like the jib sail on a sailboat, when the left ventricle pumps the blood out of the heart. This does NOT mean that the valve is leaking blood. That is called Mitral Regurgitation (MR) and can occur if the billowing valve leaflet(s) do not meet. This is called coaption. MVP is a common disorder, occurring in up to 8% of the population. In the 1980s, it seemed like people would walk around and tell all their friends that they were diagnosed with MVP. It was clearly over diagnosed and done by the physician just hearing a murmur when listening to the heart. This is NOT how MVP is diagnosed. Like all valve abnormalities, the most useful diagnostic test is echocardiography. It provides confirmatory evidence for the clinical diagnosis and helps define prognosis, risk of the valve becoming infected (Infective Endocarditis), and the degree of MR. Many patients with MVP have no symptoms. When symptoms do occur, they include chest pain, palpitations, shortness of breath, fatigue, light-headedness, and syncope “passing out.” These symptoms progress as the MR worsens. Unless one has MR, the is really nothing to be concerned about as the prognosis of MVP is generally favorable with most patients following a benign course.

Now it is time to answer the question. Currently, antibiotic prophylaxis against infective endocarditis (IE) is generally not recommended under practice guidelines for patients with a mitral valve prolapse (MVP) who are undergoing a dental procedure. People who are at high risk for IE do require antibiotic prophylaxis and is suggested only in the setting of conditions associated with the highest risk of an adverse outcome if IE occurs. This includes:

  • Prosthetic cardiac valve or material

  • Previous, relapse, or recurrent IE

  • Congenital heart disease

  • Cardiac transplant recipients who develop cardiac valve disease

The risk of a valve infection is generally considered to be the highest for dental procedures that involve manipulation of gingival tissue, the periapical region of the teeth or perforation of the oral mucosa, such as tooth extractions or drainage of a dental abscess; this includes routine dental cleaning. In contrast, the following procedures and events do not require prophylaxis: anesthetic injections through noninfected tissue, taking dental x-rays, placement or adjustment of removable prosthodontic or orthodontic appliances, placement of orthodontic brackets, shedding of primary teeth, and bleeding from trauma to lips or oral mucosa.

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