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Infective endocarditis is a rare, life-threatening disease that inflames the inner lining of your heart (endocardium). Bacteria found in dental plaque (streptococcus sanguis) are the causative agent. When there is a preexisting condition which has weakened or damaged the inner lining, bacteria are more readily able to colonize the affected tissue. Infective endocarditis is a serious condition. The periodontal pockets associated with gum disease are reservoirs for the disease-causing bacteria. Streptococcus resides in pockets adjacent to the teeth where the diseased gums have pulled away from the tooth surface. When your gums bleed as a result of the bacterial infection, the bacteria may enter your bloodstream and potentially infect other areas of your body.
The link between dental procedures and infective endocarditis is controversial. Not all dental procedures require the use of antibiotic prophylaxis in patients at risk for developing endocarditis. Dental procedures that have minimal potential to cause bleeding are considered low risk for infective endocarditis. Antibiotic prophylaxis is indicated for invasive dental procedures likely to cause bleeding and to release oral bacteria into the bloodstream. Use of prophylaxis antibiotics is also recommended for individuals with total joint replacements who have certain other health conditions.
Some other conditions which may indicate antibiotic prophylaxis include, but are not limited to, hemodialysis patients with arteriovenous shunts, in-dwelling catheters, oral surgical or operative procedures (depending on the patient's immune system), insulin-dependent diabetes, or in poorly controlled diabetics. It is recommended that you take antibiotics before dental treatment if your physician has told that you are at risk for developing infective endocarditis, or if your medical history includes one of the following conditions:
• an artificial heart valve
• congenital heart defects
• intravenous drug use
• mitral valve prolapse
• rheumatic heart disease
• valvular heart disease
Endocarditis Risk & Prophylaxis
High Risk
• Complex cyanptic congenital heart disease
• Previous bacterial endocarditis
• Prosthetic Cardiac Valves
• Surgically constructed shunts
Moderate Risk
• Hypertrophic cardiomyopathy
• Mitral valve prolapse with valvar regurgitation
• Most other congenital cardiac malformations
• Rheumatic heart disease
Negligible Risk
• Cardiac pacemakers (intravascular and epicardial) and implanted defibrillators
• Isolated secundum atrial septal defect
• Mitral valve prolapse without valvar regurgitation
• Physiologic, functional, or innocent heart murmurs
• Previous coronary artery bypass graft surgery
• Previous Kawasaki disease without valvar dysfunction
• Previous rheumatic fever without valvar dysfunction
• Surgical repair of atrial septal defect, ventricular septal defect
Endocarditis Prophylaxis Recommended
• Dental extractions
• Dental implant placement and reimplantation of avulsed teeth
• Endodontic instrumentation or surgery beyond the apex
• Initial placement of orthodontic bands but not brackets
• Intraligamentary local anesthetic injections
• Periodontal procedures including surgery, scaling and root planning
• Prophylactic cleaning of teeth or implants where bleeding is anticipated
• Subgingival placement of antibiotic fibers / strips
Endocarditis Prophylaxis Not Recommended
• Exfoliation of primary teeth (baby teeth)
• Fluoride treatments
• Intracanal endodontics
• Local anesthesia (nonintraligamentary)
• Orthodontic appliance adjustment
• Placement of removable prosthodontic/ orthodontic appliances
• Placement of rubber dam
• Post placement
• Restorative dentistry (fillings, etc)
• Taking impressions
• Taking x-rays
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