The American Heart Association (AHA) revised recommendations for antibiotic prophylaxis to prevent bacterial endocarditis following a dental procedure. Antibiotic prophylaxis is only recommended for the highest risk patients undergoing the highest risk dental procedures.


Antibiotic therapy is no longer necessary for a patient undergoing a urologic or gastrointestinal procedure.


Highest risk cardiac patients include:

(1) history of infectious endocarditis

(2) cardiac valve containing prosthetic material (entire valve or from a repair)

(3) cardiac transplant patient with an acquired valvulopathy

(4) congenital heart disease with one or more of the following:

(4a) cyanotic disease not repaired, with or without palliative conduits or shunts

(4b) completely repaired AND no residual defect AND less than 6 months since the procedure

(4c) repaired AND residual defect at site

(4d) repaired AND residual defect adjacent to a prosthetic patch or prosthetic device



• A residual defect prevents adequate endothelialization over a patch or device.

• Adequate endothelialization takes about 6 months after a complete repair.


Highest risk dental procedures include:

(1) manipulation of the gingival tissue

(2) manipulation of the periapical region of a tooth

(3) any perforation of the oral mucosa (except in the list below)


Manipulations may include:

(1) cleaning

(2) biopsying

(3) removing a suture

(4) extracting a diseased tooth


The highest risk dental procedures do not include:

(1) routine injection of a local anesthetic through noninfected tissue

(2) taking dental radiographs

(3) placing a removable orthodontic or prosthodontic appliance

(4) adjusting an orthodontic appliance

(5) placing orthodontic brackets

(6) shedding a deciduous tooth (in a child)

(7) bleeding from trauma to the oral mucosa or lips


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