In 2022 - There is update of American Heart Association's 2007 Recommendation for Prevention of Infective Endocarditis - related to select Dental Procedure.
The following procedures and events DO NOT need prophylaxis for high risk patients:
/ routine anesthetic injection through noninfected soft tissue
/ 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 mucosa
** For clarity, the AHA guidelines state that prophylactic antibiotics, which were previously routinely administered to certain patients, are no longer needed for such patients.
Antibiotic prophylaxis is reasonable before select dental procedures (^procedures that involve manipulation of gingival (gum) tissue or the periapical region -area around the roots - of teeth, or perforation of the oral mucosa.^) for people with heart valve disease who have any of the following:
/ Prosthetic cardiac valves, including transcatheter-implanted
/ prostheses and homografts.
/ Prosthetic material used for heart valve repair, such as annuloplasty rings, chords or clips.
/ Previous IE.
/ Unrepaired cyanotic congenital heart defect (birth defects with oxygen levels lower than normal) or repaired congenital heart defect, with residual shunts or valvular regurgitation at the site adjacent to the site of a prosthetic patch or prosthetic device.
/ Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
Except for the conditions listed above, antibiotic prophylaxis before dental procedures is NOT RECOMMENDED for any other types of congenital heart disease.
In addition, antibiotic prophylaxis is NOT RECOMMENDED for patients with valvular heart disease who are at high risk of IE for nondental procedures (e.g., TEE, esophagogastroduodenoscopy, colonoscopy, or cystoscopy) in the absence of active infection.
Good oral health and infection prevention is the ULTIMATE GOAL - Patient can reduce the risk of IE by maintaining good oral health through regular professional dental care and the use of dental products such as manual, powered and ultrasonic toothbrushes; dental floss; and other plaque-removal devices.
1) Canadian Dental Association Position 2021- http://www.cda-adc.ca/en/about/position_statements/InfectiveEndocarditis/
2) American Heart Association topics on infective endocarditis - https://www.heart.org/en/health-topics/infective-endocarditis