Antibiotic Prophylaxis

The following medical conditions require antibiotic prophylaxis for dental procedures where bacteremia could occur such as after manipulation of gingiva or the tooth apex or when oral mucosa is perforated:

  • Prosthetic cardiac valves, including transcatheter-implanted protheses and homografts
  • Prosthetic material used for cardiac valve repair - annuloplasty rings and chords
  • Previous Infective Endocarditis
  • Unrepaired cyanotic congenital heart disease or repaired congenital heart disease with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device
  • Cardiac transplant with valve regurgitation due to a structurally abnormal valve
  • See 2017 AHA guidelines

The following medical conditions may require antibiotic prophylaxis for certain dental procedures:

  • Vascular grafts (less than 6 months old)
  • Arteriovenous hemodialysis shunts
  • Neurosurgical shunts (dependent on type)
  • Indwelling vascular catheters

Antibiotic prophylaxis prior to undergoing dental procedures is not required for patients with cardiovascular implantable devices, such as defibrillators or pacemakers.

Prophylactic antibiotics are generally NOT recommended for patients with prosthetic joint implants, prior to dental procedures

References

Watters W et al. Prevention of Orthopaedic Implant Infection in Patients undergoing Dental Procedures: Executive Report. J the Am Acad of Orthopedic Surgery. 2013; 21: 180-189.

Baddour LM et al. A summary of the update on cardiovascular implantable electronic device infection and their management. JADA. 2011; 142(2): 159-165.

Berbarie EF et al. Dental procedures as a risk factor for prosthetic hip or knee inf. Clinical Infectious Disease. 2010; 50: 8-16.

Little JW, Jacobson JJ, Lockhart PB. American Academy of Oral Medicine. The Dental Treatment of Patients with Joint Replacement: A Position Paper from the American Academy of Oral Medicine. JADA. 2010; 141(6): 667-71.

Sollecito TP, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners-a report of the American Dental Association Council on Scientific Affairs. The Journal of the American Dental Association. 2015; 146(1): 11-16e. 

Wilson WH, et al. Prevention of infective endocarditis: Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. ADA. 2008; 139(1): 3s-24s.

Guideline on Antibiotic Prophylaxis for Dental Patients at Risk for Infection, American Academy of Pediatric Dentistry Council on Clinical Affairs, 2014; 37(6) Accessed on 1/26/2018

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, 3rd, Fleisher LA, et al. 2017 AHA/ACC Focused Update of the 2014AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135(25): e1159-e1195.