The guidelines for when to premedicate with antibiotics have been laid out and can be found on the American Dental Association’s website⁷. This post will cover some information on each condition that premedication is called upon for IE.

We know that prophylactic premedication for Infective Endocarditis is warranted if a patient presents with any of these in their medical history, word for word from the American Heart Association¹:

1. A prosthetic heart valve or who have had a heart valve repaired with prosthetic material.
2. A history of endocarditis.
3. A heart transplant with abnormal heart valve function
4. Certain congenital heart defects including:
   • Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), that has not been fully repaired, including children who have had a surgical shunts and conduits.
   • A congenital heart defect that’s been completely repaired with prosthetic material or a device for the first six months after the repair procedure.
   • Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device.

1. Reasons why someone might have Prosthetic Heart Valve or a Valve Repaired
   • A patient may receive a partial or full prosthetic valve replacement if they have or have had-
     1. Aortic Stenosis: usually caused by a degenerative calcification of heart valve or a narrowing of the heart valves.
     2. Aortic Regurgitation: can be caused by ascending aortic disease or rheumatic heart disease, allows blood back into the heart.
     3. Mitral Regurgitation: this occurs when the mitral valve does not close tightly enough for any number of reasons. Most common form of valvular hear disease⁸.
     4. Mitral Stenosis: may also be caused by rheumatic fever. Patients who are not candidates for percutaneous balloon valvotomy may have valve replacement².
2. History of Infective Endocarditis:
   • Some of the Signs and Symptoms of an upcoming IE event–
     1. aching joints and muscles
     2. chest pain
     3. fever, chills, and/or fatigue
     4. shortness of breath
     5. changed or new heart murmur sounds
   • Potential for Severe Complications– The vegetations of bacteria or fungi that build up in/on the heart can break lose and lodge in the brain, lungs, appendages, or any other organ³.
   • If a patient has a history of infective carditis, coordination with the patient’s cardiologist is paramount.
3. Heart Transplant with Abnormal Valve Functioning:
   • Regurgitation aka leaky valves–allow blood back into the heart when it should be pumped out.
   • Stenosis aka narrowing of the valves–less blood is pumped out of the heart, even though it is pumping harder⁴.
   • These problems in a transplanted heart can cause turbulent flow, usually the culprit of Infective Endocarditis.
4. Congenital Heart Defects:
   • Usually, these heart defects occur within the first 8 weeks in the womb for babies⁹.
   • There is a long list of different types of Congenital Heart Defects⁵.
   • The AHA makes note that unrepaired Cyanotic Congenital Heart Defects need specific attention
   • These can include, but may not be limited to⁶—
     1. Transposition of great arteries
     2. Tetralogy of Fallot
     3. Tricuspid atresia
     4. Truncus arteriosus

Summary: This post hopefully shed some light on some of the conditions that currently do need antibiotic prophylaxis for Infective Endocarditis. Please refer back to the ADA or AHA guidelines for when to use prophylactic antibiotics^1,7.

1. Infective endocarditis. (n.d.). Retrieved February 10, 2021, from https://www.heart.org/en/health-topics/infective-endocarditis
2. Maganti, K., Rigolin, V. H., Sarano, M. E., & Bonow, R. O. (2010). Valvular heart disease: diagnosis and management. Mayo Clinic proceedings, 85(5), 483–500. https://doi.org/10.4065/mcp.2009.0706
3. Endocarditis. (2020, November 14). Retrieved February 10, 2021, from https://www.mayoclinic.org/diseases-conditions/endocarditis/symptoms-causes/syc-20352576
4. Heart valve diseases. (n.d.). Retrieved February 10, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-valve-diseases
5. What are congenital heart defects? (2020, November 17). Retrieved February 11, 2021, from https://www.cdc.gov/ncbddd/heartdefects/facts.html
6. Hughes S, Balmer R, Moffat M, et al: The dental management of children with congenital heart disease following the publication of Paediatric Congenital Heart Disease Standards and Specifications.  Br Dent J 226:447-452, 2019
7. Antibiotic prophylaxis prior to dental procedures. (n.d.). Retrieved February 11, 2021, from https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
8. Weinrauch, LA (2008-05-12). “Mitral regurgitation – chronic”. Medline Plus Encyclopedia. U.S. National Library of Medicine and National Institutes of Health. Retrieved 2009-12-04.
9. Congenital heart disease. (n.d.). Retrieved February 11, 2021, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02346

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