Damaged mitral valve.

Note perforation (black arrows) and bacterial vegetations (white arrow) caused by bacterial endocarditis. The roughened surfaces make this valve susceptible to recurrent endocarditis.

Following is a summary of the 1997 American Heart Association Guidelines for bacterial endocarditis prophylaxis:

*Total children's dose should not exceed adult dose.

**Cephalosporins should not be used in individuals with immediate hypersensitivity reaction (urticaria, angioedema or anaphylaxis) to penicillins.

Note that the postoperative dosage has been eliminated. Erythromycin has been eliminated as a recommended drug for the penicillin-allergic patient because of the high incidence of gastrointestinal upset and confusion over the variability of the pharmacokinetics of the different forms of erythromycin.

The recommendations for use of antibiotic prophylaxis to prevent late infection of prosthetic joint replacements have also been updated. Routine antibiotic prophylaxis is no longer recommended for prosthetic joints placed more than two years previously. Details of these recommendations, along with numerous caveats and special circumstances, are described in the July 1997 JADA.

Please refer to the original articles for complete information. These summaries are given for convenience only and it is expected that the treating dentist or physician is familiar with the content of the referenced material.

REFERENCES

1. Danjani AS, et al. Prevention of bacterial endocarditis: Recommendations by the American Heart Association. JADA, August 1997; 128: 1142-1151
2. American Dental Association, American Academy of Orthopaedic Surgeons. Antibiotic prophylaxis for dental patients with joint replacements. JADA, July 1997; 128:1004-1008

Health Alert for Patients Exposed to Weight Reduction Drugs

The drugs fenfluramine (Pondimim) or dexphenfluramine (Redux) either alone, or in combination with phentermine, have been withdrawn from the market. However, approximately four million people in the U.S. may have taken these drugs. According to recent studies nearly one-third of those who took these drugs (especially females), developed asymptomatic heart valve abnormalities.

Certain dental procedures performed on those patients with valve irregularities could result in bacterial endocarditis. Any of your patients who have taken diet pills should be referred to their physician for an appropriate evaluation before undergoing any procedure that could cause a bacteremia. If valve damage is confirmed, the current American Heart Association recommendations for prevention of bacterial endocarditis should be followed.