A number of common dental procedures can lead to life-threatening heart infections in patients with pre-existing cardiac conditions:
- prosthetic heart valves
- artificial valve rings
- unrepaired heart defects
The American Dental Association says these patients should get antibiotics before their procedure, but some dentists aren’t following the rules. Our experienced dental malpractice lawyers can help. Call for a free consultation today.
Medical malpractice is always unacceptable. Dentists are bound to the standard of care just like other medical professionals.
"Talented" Laurence was extremely thorough in his investigation.
The normal human mouth is home to over 200 different types of bacteria. Some of these microorganisms are perfectly safe; in fact, many of them, like the probiotics, perform vital functions that encourage human health. Other forms of bacteria aren’t so desirable.
Oral Bacteria Drive Life-Threatening Heart Infections
Inside the human mouth, colonies of Streptococcus mutans, one species commonly found in the mouth, eat up starches and sugars while producing lactic acid, the leading driver of tooth decay and other oral diseases.
When dentists talk about “plaque” on your teeth or gums, they’re referring to colonies of bacteria. And when these colonies grow, they can lead to infections, like the gum infection known as gingivitis, break down the enamel that coats our teeth or destroy the teeth entirely. While bacteria can be either friend or foe, it’s likely that, if you’ve ended up in the dentist’s office for a procedure, some species of microorganism is at the root of your problem.
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How Bacteria Enters The Blood
It’s a different situation altogether when bacteria are allowed to enter the human blood stream. Once a pathogen has infiltrated the blood, it can flow almost anywhere, including to the heart. Developing an infection in heart tissue is a serious problem.
As you might expect, heart infections can lead to life-threatening complications, from congestive heart failure and stroke to a heart attack. So how does bacteria get into the bloodstream? One more common pathway might surprise you, but it’s also the subject we began with: a dentist’s appointment.
Some forms of oral disease, including gingivitis, cause bleeding in the gums. That’s a pathway. When a hole opens up between the mouth and the rest of your body, bacteria can get in and cause all sorts of problems. But pathways can also be created when a dentist manipulates your gums during a procedure, digs around at the root of a tooth or accidentally pierces the mouth’s lining, a layer of tissues called the oral mucosa.
Dentists and orthodontists have to be very careful. The goal of treatment is two-fold. One the one hand, we want to solve oral problems. And on the other, we need to reduce the risk of potential complications, like creating a pathway for oral bacteria to enter the blood.
Heart Valves, Transplants Increase Risk
As it turns out, dentists and other oral health professionals need to be particularly careful with certain patients. Most people have healthy immune systems that can target and destroy bacterial invaders. This defense system comes in particularly handy when bacteria are planning on infecting heart tissue, since the heart is one of the most important organs.
The disease we’re trying to prevent here is called infective endocarditis. Sometimes, you might see it referred to as bacterial endocarditis. The two terms are used interchangeably. It’s the same infection of endocardium, the type of tissue that lines the insides of heart chambers and valves. In the best cases, infective endocarditis can be effectively treated through a regimen of antibiotics. Severe cases often require invasive surgical procedures.
Who Should Take Antibiotics Before Dentistry?
Your immune system is really good at handling infections that have begun on normal human tissue. It’s not so smart when artificial materials are involved. Things like synthetic heart valves and surgical mesh really confuse the immune system; it usually doesn’t consider these artificial implants to be part of “you.” The same logic applies to people who have received tissue grafts or heart transplants; the immune system doesn’t quite know what to do with these things, so it doesn’t defend them as strongly as your normal tissues.
The problem, then, is complex and multi-faceted. Most people won’t need any special medical treatment before undergoing a dental procedure. While tooth extraction or gum surgery could, in theory, allow bacteria to enter the blood, most of us are equipped with immune systems that are up to the task. Even more importantly, the majority of people have body tissue that their immune systems recognize. But some of us don’t.
Some of us have received heart transplants. Others have artificial heart valves. Some of us have surgical mesh covering holes in our hearts that we were born with. And if you fall into any of those categories, you deserve special treatment.
Underlying Cardiac Conditions
As the American Dental Association reports, patients with certain underlying cardiac problems should receive antibiotics before undergoing a selection of common dental procedures. According to current guidelines, supported both by the American Dental Association and the American Heart Association, these prophylactic antibiotics should be prescribed to the following groups of dental patients:
- people with a history of infective endocarditis
- patients with prosthetic cardiac valves, including homografts (donor tissue)
- people implanted with prosthetic materials during heart valve repair procedures (like an annuloplasty ring)
- heart transplant patients who have leaky valves due to a structural abnormality
- people who were born with certain congenital heart defects:
- unrepaired cyanotic heart defects
- Transposition of the Great Arteries
- Truncus Arteriosis
- Hypoplastic Left Heart Syndrome
- Tetralogy of Fallot
- Coarctation of the aorta
- Total Anomalous Pulmonary Venous Connection
- Tricuspid displacement (Ebstein’s anomaly)
- Tricuspid stenosis
- Tricuspid atresia
- repaired congenital heart defects with residual shunts or valve regurgitation (leaking) near the site of a prosthetic implant
- people who recently received prosthetic implants for a congenital heart defect (antibiotics only advised within first six months of heart procedure)
- unrepaired cyanotic heart defects
Dental patients who fall under any of the categories listed above, experts agree, should be prescribed antibiotics prior to any procedure that poses a risk of bacterial infection.
Antibiotics Only Recommended For Certain Procedures
That’s not every dental procedure. As we mentioned above, doctors are especially worried about treatments in which the gums are manipulated, the tip of a tooth’s root will be manipulated or the mouth’s inner lining is likely to be perforated. Where at-risk patients are concerned, antibiotics should be prescribed before these procedures.
The American Heart Association also provides a list of dental procedures before which antibiotics are not required:
- routine anesthetic injections through non-infected tissue
- taking dental radiographs
- placement of removable prosthodontic or orthodontic appliances
- adjustment of orthodontic appliances
- placement or orthodontic brackets
- shedding of deciduous teeth
- bleeding from trauma to the lips or oral mucosa
These procedures, according to the current 2017 guidelines, do not increase the risk of infective endocarditis so much that prophylactic antibiotics would be beneficial.
Medical Malpractice & The Standard Of Care
This is the current standard of care within the dental and orthodontic communities. That’s a very important concept in the area of medical malpractice. Medical professionals are obligated by state law to follow the standard of care active in their field. And when a doctor falls below the standard of care, providing sub-standard medical treatment, he or she can be held liable, in court, for any injuries that come as a result of that failure.
In short, dentists who fail to prescribe antibiotics to patients who live at risk of developing infective endocarditis can be held accountable for their negligence. Some patients may be able to pursue significant financial compensation by filing a civil lawsuit. Likewise, families who have lost a loved one to infective endocarditis may be eligible to file a wrongful death case against the responsible parties.
Who Can File An Infective Endocarditis Lawsuit?
Our experienced attorneys have noticed a surprising increase in the number of medical malpractice lawsuits filed over cases of infective endocarditis linked to dental care. And our investigations have discovered evidence that many dentists and orthodontists across the country aren’t prescribing antibiotics to at-risk patients.
For obvious reasons, that failure can be disastrous. We’ve heard from dozens of patients who developed severe heart infections after undergoing a routine dental procedure. Most of these people were living with cardiac valve implants, but were never prescribed the antibiotics that could have saved them from months of pain, thousands of dollars in unnecessary medical bills and significant emotional and mental trauma.
We consider this a grave injustice. The American Dental Association’s 2017 guidelines are clear. There’s no excuse for violating them, especially when a violation of clinical standards results in severe patient harm.
Free Dental Malpractice Consultations
To learn more about your legal options, contact our experienced medical malpractice attorneys today. We offer free consultations, so you can find the information you need at absolutely no risk and no obligation. Just call or complete our online contact form to get in touch with a dedicated legal representative now.
We’ll help you understand your rights as a medical patient and discuss the possibilities for moving forward at no charge. And if we can help in your case, our lawyers offer their services on a contingency-fee basis. That means you pay us nothing until we secure compensation in your case.