Infective Endocarditis

New guidelines for prevention of infective endocarditis were released by the American Heart Association April 193 The AHA and ADA now recommend that fewer dental patients with heart disease receive antibiotic prophylaxis before dental procedures to prevent the heart infection called invective endocarditis (IE). The guidelines were developed by a group appointed by the AHA that included experts in infectious disease and cardiology and members representing the ADA. The guidelines were endorsed by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society.

After reviewing relevant scientific literature from 1950-2006, the group concluded that bacteremia resulting form daily activities is much more likely to cause IE than bacteremia associated with a dental procedure. In addition, only an extremely small number of IE cases might be prevented by antibiotic prophylaxis, even if prophylaxis is 100% effective. Based on these conclusions, antibiotic prophylaxis is now recommended before dental procedures only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE, such as patients with artificial heart valves, a history of endocarditis, certain serious congenital heart conditions and heart transplant patients who develop a problem with a heart valve.

For more details see ADA.org.

Cardiac Conditions Associated with the Highest Risk of Adverse Outcome from Endocarditis for Which Prophylaxis with Dental Procedures is Recommended

Prosthetic cardiac valve
Previous infective endocarditis
Congenital heart disease (CHD)*
- Unrepaired cyanotic CHD, including palliative shunts and conduits
- Completely repaired congenital heart defect with prosthetic material or divice, whether placed by surgery or by catheter intervention during the first six months after the procedure**
- Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (whic inhibit endothellalization)
Cardiac transplantation recipients who develop cardiac valvulopathy

*Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD

**Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months after the procedure

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