Cardiovascular
Dental Management of Patients with Previous infective endocarditis
Antibiotic prophylaxis indicated (previous IE)
Previous infective endocarditis is a high-risk cardiac condition. Prophylaxis is recommended for procedures involving gingival/periapical manipulation or mucosal perforation.
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
- • Treat any dental infection immediately — it is a potential source of recurrent endocarditis; refer if fever or malaise.Ref: Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978
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
- • Highest-risk group: intensive prevention and close recall.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)
- • Penicillin-allergic alternatives per AHA 2021
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 (previous IE) |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Antibiotic prophylaxis indicated (previous IE) |
| Root canal treatment | ROUTINE No prophylaxis needed for this procedure |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Antibiotic prophylaxis indicated (previous IE) |
| Surgical / bony extraction | MODIFY / CAUTION Antibiotic prophylaxis indicated (previous IE) |
| Implant placement | MODIFY / CAUTION Antibiotic prophylaxis indicated (previous IE) |
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
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.