Cardiovascular

Dental Management of Patients with Bioprosthetic / tissue (animal) valve

Antibiotic prophylaxis indicated (bioprosthetic/tissue valve)

Any prosthetic cardiac valve — including a bioprosthetic (tissue/animal) or transcatheter valve, or a valve repaired with prosthetic material — is a high-risk cardiac condition. Prophylaxis is recommended for procedures involving gingival/periapical manipulation or mucosal perforation (AHA 2021).

Emergency vs routine management

If EMERGENCY — what to do

• Antibiotic prophylaxis 30–60 min before: amoxicillin 2 g orally (child 50 mg/kg). Penicillin-allergic: azithromycin/clarithromycin 500 mg or doxycycline 100 mg — clindamycin is no longer recommended. If missed, it can be given up to 2 h after the procedure.Ref: Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978
• Check for anticoagulation (common in the first 3–6 months after implantation) — INR on the day if on warfarin.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022

If ROUTINE — what to do

• Prophylaxis is required for every procedure involving gingival manipulation, the periapical region or perforation of the oral mucosa — not for routine LA injections through non-infected tissue or radiographs.Ref: Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978
• Regular preventive care and 6-monthly review.Ref: Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978

Clinical precautions

• Amoxicillin 2 g PO 30–60 min before (adult)
• If penicillin-allergic: Cephalexin 2 g, Azithromycin/Clarithromycin 500 mg, or Doxycycline 100 mg
• If already on antibiotics, choose a different class

At a glance by procedure

Initial assessment before lab results or timing details are entered.

Procedure	Initial assessment
Examination / radiographs	ROUTINE No prophylaxis needed for this procedure
Supragingival scaling / polish	MODIFY / CAUTION Antibiotic prophylaxis indicated (bioprosthetic/tissue valve)
Deep scaling / subgingival RSD (subgingival calculus)	MODIFY / CAUTION Antibiotic prophylaxis indicated (bioprosthetic/tissue valve)
Root canal treatment	ROUTINE No prophylaxis needed for this procedure
Simple extraction (1–3 teeth)	MODIFY / CAUTION Antibiotic prophylaxis indicated (bioprosthetic/tissue valve)
Surgical / bony extraction	MODIFY / CAUTION Antibiotic prophylaxis indicated (bioprosthetic/tissue valve)
Implant placement	MODIFY / CAUTION Antibiotic prophylaxis indicated (bioprosthetic/tissue valve)

Get a patient-specific decision in seconds

Combine all conditions, medications, lab results and the planned procedure — with anaesthetic dose calculation, lab requests and a referral letter PDF.

References

AHA 2021 — Prevention of Infective Endocarditis
Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978
SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022

This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.