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What Endocarditis high-risk patients require specific care?

Some people are at high risk of developing an infection of the heart’s inner lining (bacterial Endocarditis). These patients must take special care to practice good oral hygiene every day. Traditionally, many of these patients were advised to take antibiotics before having dental work; however, the American Heart Association revised their guidelines to state that only people at the highest risk of developing bacterial Endocarditis will reasonably benefit from taking preventive antibiotics before certain procedures.

All patients scheduled for valve surgery need to have excellent oral hygiene and see a dentist before surgery because unhealthy teeth are one source of bacteria that can cause Endocarditis. (5)

 

Endocarditis Prophylaxis

Cardiac conditions that require endocarditis prophylaxis

  • Prosthetic cardiac valve, including a transcatheter valve or prosthetic material used for cardiac valve repair.
  • Previous infective Endocarditis
  • Patients with congenital heart disease

The following forms of congenital heart disease (CHD):

Any cyanotic heart disease

  • Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or
  • catheter intervention, during the first six months after the procedure or lifelong, if residual shunt or valvular regurgitation remains
  • Repaired CHD with residual defects at or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit reendothelialization)
  • Endocarditis prophylaxis is recommended in patients with the above cardiac conditions for all dental procedures that involve:
  • Manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa, including scaling and root canal procedures.

Dental Procedures in Adults and Children

Endocarditis prophylaxis is NOT recommended for the following procedures

✔️Routine anesthetic injections through non-infected tissue

✔️taking dental radiographs

✔️placement of removable prosthodontic or orthodontic appliances

✔️adjustment of orthodontic appliances

✔️placement of orthodontic brackets

✔️shedding of deciduous teeth

✔️bleeding from trauma to the lips or oral mucosa, which also includes treatment of superficial caries, removal of sutures, etc. (6)

References:
(1)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770162/
(2)https://www.mayoclinic.org/healthy-lifestyle/adult-health
(3),(4) https://my.clevelandclinic.org
(5)https://my.clevelandclinic.org/health/articles/11264-oral-health--risk-for-cv-Disease
(6)https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/dental/endocarditis-prophylaxis/

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