Heart Conditions and Routine Dental Care:

Mitral Valve Prolapse and Heart Murmur

by Carey O’Rielly, DDS

Demand for routine dental hygiene has become progressively greater as longevity and awareness of prevention have increased. However, anytime someone receives a cleaning, a condition called bacteremia results whereupon bacteria are released into the blood. Localized, low level infection can then spread to more distant organs of the body, a more common occurrence than has been widely understood.

When you consider how many cleanings you will receive in your lifetime, instances of bacteremia create a situation in which someone with a pre-existing heart conditions can be particularly vulnerable. Just as a stream forms eddies as it flows around objects, the blood within the heart can flow in a similar manner when there is a heart murmur or mitral valve prolapse . When the heart valves malfunction, pockets of stagnant blood are created allowing bacteria to gain a foothold and grow into an infection that can attack the heart muscle itself.

Heart murmur is a fairly common condition in which inefficient heart valves impair the circulation of blood. Heart murmurs usually occur as a byproduct of rheumatic fever. Mitral valve prolapse (MVP) is another condition in which a heart valve fails to operate normally. The mitral valve separating the upper left chamber (atrium) from the lower left chamber (ventricle) does not close properly.

The danger of MVP is that infected areas of stagnant blood may go undetected for long periods of time, while the patient wonders why they are continuously tired and their health seems to be deteriorating. To prevent this from happening, dentists often insist that patients with MVP take antibiotics before having their teeth cleaned or worked on so that bacteremia can be controlled.

Frequently, patients with MVP will prefer not to take antibiotics for something that has less perceived impact on them than antibiotics. Some patients prefer to take as few medications as possible and, after all, antibiotics can affect our intestinal flora. The decision requires a clear perspective. On the one hand we have the short term and sometimes unpleasant side effects of antibiotics. On the other, there is the cumulative affect of bacteremia and its ability to undermine the long term health of the heart in the presence of MVP. In addition to this it is important to know that a heart infection that affects the heart lining is a serious condition and potentially life threatening.

It is useful to realize that the side effects of antibiotics can be countered by taking a potent “probiotic” containing strains of bacteria that promote intestinal health. Friendly microbes such as Lactobacillus, Acidophilus, Salivarus and Plantarum create colonies in our digestive organs that can replace the activities of naturally-occurring bacteria until these can be replenished. For some, this support may tip the scales in favor of the necessary precaution for MVP.

Unpleasant as antibiotics may be for some and obscure as the condition appears to be, when your dentist asks you to pre-medicate for MVP, s/he really has your best interests at heart.