Antibiotic pre-medication is required for cardiac conditions associated with high risk for developing infective endocarditis. There are five conditions associated with adverse outcomes for which prophylaxis for dental treatment is indicated:
Prosthetic heart valve, which includes transcatheter-implanted prostheses and homografts.
Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords.
Previous history of infective endocarditis.
Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
Congenital heart disease (CHD), or conditions which have been present since. Specifically, the following two CHD’s are a concern:
Unrepaired cyanotic CHD, including palliative shunts and conduits
Repaired CHD defect with residual shunts or valvular regurgitation at the site of, or adjacent to the site of, a prosthetic patch or a prosthetic device (Figure 2).8,9
Table 2 provides questions that are helpful for oral health practitioners to ask when reviewing the medical history of patients suspected of having high risk cardiac conditions.
|Table 1. Antibiotic Premedication Treatment Examples 1|
|These cases DO need antibiotic premed if there is manipulation of gingival tissue or periapical region of teeth, or perforation of oral mucosa, such as:||These procedures are ok to perform WITHOUT antibiotic premed:|
In summary, premedication is most often indicated in situations involving severe valvular conditions. These premedication requirements are standard protocol per the ADA and American Heart Association (AHA) and do not require a medical consult. However, congenital heart conditions will often times require a consult with the medical provider to determine specific antibiotic prophylactic needs.