Patients with underlying cardiac conditions may require prophylactic antibiotics to reduce chance of developing bacterial endocarditis following dental procedures.
Cardiac risk categories of underlying cardiac disease:
(1) high
(2) moderate
(3) negligible
|
Cardiac Condition |
Risk Category |
|
prosthetic cardiac valve |
high |
|
history of previous bacterial endocarditis |
high |
|
complex cyanotic congenital heart disease (transposition of great vessels, tetralogy of Fallot, single ventricle states) |
high |
|
after surgical repair of atrial septal defect, ventricular septal defect or patent ductus arteriosus (without residua beyond 6 mos.) |
negligible |
|
isolated secundum atrial septal defect |
negligible |
|
congenital cardiac malformations not listed above |
moderate |
|
surgically constructed systemic pulmonary shunts or conduits |
high |
|
acquired valvar dysfunction, including rheumatic heart disease |
moderate |
|
previous rheumatic fever without valvar dysfunction |
negligible |
|
hypertrophic cardiomyopathy |
moderate |
|
mitral valve prolapse with valvar regurgitation and/or thickened leaflets |
moderate |
|
mitral valve prolapse without valvar regurgitation |
negligible |
|
previous coronary artery bypass graft surgery |
negligible |
|
physiologic, functional or innocent heart murmurs |
negligible |
|
previous Kawasaki disease without valvar dysfunction |
negligible |
|
cardiac pacemaker (intravascular and epicardial) |
negligible |
|
implanted defibrillator |
negligible |
|
Dental Procedure |
Prophylaxis |
|
dental extraction |
recommended |
|
periodontal procedure |
recommended |
|
dental implant placement |
recommended |
|
reimplantation of avulsed teeth |
recommended |
|
endodontic (root canal) instrumentation or surgery only beyond the apex |
recommended |
|
subgingival placement of antibiotic fibers or strips |
recommended |
|
initial placement of orthodontic bands but not brackets |
recommended |
|
intraligamentary local anesthetic injections |
recommended |
|
prophylactic cleaning of teeth or implants where bleeding is anticipated |
recommended |
|
restorative dentistry with or without retraction cord |
usually not recommended, but may be given if significant bleeding expected |
|
local anesthetic injections, nonintraligamentary |
not recommended |
|
intracanal endodontic treatment |
not recommended |
|
placement of rubber dams |
not recommended |
|
postoperative suture removal |
not recommended |
|
placement of removable prosthodontic or othrodontic appliances |
not recommended |
|
taking of oral impressions |
not recommended |
|
fluoride treatment |
not recommended |
|
taking of oral radiographs |
not recommended |
|
orthodontic appliance adjustment |
not recommended |
|
shedding of primary teeth |
not recommended |
Prophylaxis is given in recommended circumstances to patients with moderate and high risk conditions.
Specialty: Infectious Diseases, Pharmacology, clinical
ICD-10: ,
