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Fewer Patients Need to Take Antibiotics for Dental Care

Dear Dr. Roach: I just read the question from “B” on bacterial endocarditis. I had bacterial endocarditis seven years ago, and I’ve also had a mitral valve prolapse heart murmur for decades. You advised “B” that, if you’ve had bacterial endocarditis, “You have to take antibiotics before any dental work that seeds the blood with bacteria.” Didn’t the American Heart Association rescind or modify its recommendation on that several years ago?

I had stopped the prophylaxis a few years ago, on the advice of my cardiologist and acquiescence of my dentist. Should I resume my former prophylaxis treatment? Thanks! — D.R.

Answer: The American Heart Association did indeed change its recommendations in 2007, and sharply limited the people who should receive antibiotics to prevent bacterial endocarditis. Now the only people for whom antibiotics are recommended before dental procedures are people with a history of endocarditis, people with a prosthetic heart valve or prosthetic material used in surgery, people with a heart transplant and valve disease, and those with unrepaired congenital heart disease. Because of your history of endocarditis, your valves are at high risk for becoming infected again, so you still should have prophylaxis, and for the rest of your life.

Mitral valve prolapse or other valve disorders are no longer considered an indication for antibiotics before dental procedures. Some doctors and patients will be uncomfortable with this, but I agree with the new recommendations.

Dear Dr. Roach: I am a kindergarten teacher and wonder how long germs can stay alive on toys. Can a germ lie dormant on a toy for long periods of time, or will a germ die shortly after contact with an object? We have had quite a bit of flu going around, and want to take every precaution we can. We wonder if the spread of germs can be largely attributed to the toys. — J.P.

Answer: How long a germ can live depends on the germ. For flu, the studies have shown that the virus can live between two and eight hours on a hard surface. There are other germs that are much more hardy. In a worst-case scenario, the spores of Clostridium dificile, the bacterium that causes diarrhea associated with antibiotics and hospitals, can live for up to two years, and it is resistant to chemicals. This is one of the reasons it is so hard to eradicate from hospitals. Frequent hand-washing is important not because the soap kills the spores, but because it washes them away.

Some kindergarten teachers have used washing away germs as a class lesson, which I think is a great idea.

Dr. Roach Writes: I recently wrote a column about leg cramps, and the response from my readers did not disappoint. The most common advice was tonic water, but pinching the skin during a cramp, air-filled compression stockings and turmeric were other suggestions. The U.S. Food and Drug Administration has warned against using prescription quinine for leg cramps.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or mail them to P.O. Box 536475, Orlando, FL 32853-6475.