Cardiovascular
Dental Management of Patients with Prosthetic heart valve (mechanical)
Antibiotic prophylaxis indicated (high-risk cardiac)
Prosthetic heart valve is a high-risk cardiac condition. For procedures involving manipulation of gingival tissue, the periapical region or perforation of oral mucosa, antibiotic prophylaxis is recommended (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
- • If anticoagulated: check INR on the day; extraction can proceed if INR < 4 with local haemostasis.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
- • Maintain excellent oral health; 6-monthly review — poor oral health is a major endocarditis source.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 (high-risk cardiac) |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Antibiotic prophylaxis indicated (high-risk cardiac) |
| Root canal treatment | ROUTINE No prophylaxis needed for this procedure |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Antibiotic prophylaxis indicated (high-risk cardiac) |
| Surgical / bony extraction | MODIFY / CAUTION Antibiotic prophylaxis indicated (high-risk cardiac) |
| Implant placement | MODIFY / CAUTION Antibiotic prophylaxis indicated (high-risk cardiac) |
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
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.