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Many of you take an antibiotic prior to dental treatment. The purpose is to use an antibiotic prior to an infection to prevent an infection. It may be because of a mitral valve prolapse, certain types of implants, a joint replacement, or a heart murmur cause by a roughened heart valve. Antibiotic prophylaxis began initially to prevent bacterial endocarditis. Endocarditis is the collection and colonization of bacteria in the heart muscle. This leads to inflammation and deformation of the heart and is a life-threatening condition.

Antibiotic prophylaxis was recommended for the following:

High-risk category

Prosthetic cardiac valves,including bioprosthetic and homograft valves
Previous bacterial endocarditis
Complex cyanotic congenital heart disease (e.g., single ventricle states, transposition of the great arteries, tetralogy of Fallot) Surgically constructed systemic pulmonary shunts or conduits

Moderate-risk category

Most other congenital cardiac malformations (other than above and below)
Acquired valvar dysfunction (e.g., rheumatic heart disease)
Hypertrophic cardiomyopathy
Mitral valve prolapse with valvar regurgitation and/or thickened leaflets

Antibiotic prophylaxis is NOT RECOMMENDED for the following:

Negligible-risk category (no greater risk than the general population)

Isolated secundum atrial septal defect
Surgical repair of atrial septal defect, ventricular septal defect, or patent ductus arteriosus
Previous coronary artery bypass graft surgery
Mitral valve prolapse without valvar regurgitation
Physiologic, functional, or innocent heart murmurs
Previous Kawasaki disease without valvar dysfunction
Previous rheumatic fever without valvar dysfunction
Cardiac pacemakers (intravascular and


Antibiotic prophylaxis is recommended for the following dental procedures:

Dental extractions
Periodontal procedures including surgery, scaling and root planing, probing, and recall maintenance
Dental implant placement and re-implantation of avulsed teeth
Endodontic (root canal) instrumentation or surgery only beyond the apex
Subgingival placement of antibiotic fibers or strips
Initial placement of orthodontic bands but not brackets
Intraligamentary local anesthetic injections
Prophylactic cleaning of teeth or implants where bleeding is anticipated


Antibiotic prophylaxis is not recommended for the following dental procedures
Restorative dentistry (operative and prosthodontic) with or without retraction cord
Local anesthetic injections (nonintraligamentary)
Intracanal endodontic treatment; post placement and buildup
Placement of rubber dams, postoperative suture removal, taking of oral impressions, and fluoride treatments
Placement of removable prosthodontic or orthodontic appliances and orthodontic appliance adjustment
Taking of oral radiographs
Shedding of primary teeth


Cardiac Conditions Associated With the Highest Risk of Adverse Outcome From Endocarditis for Which Prophylaxis With Dental Procedures Is Reasonable

Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
Previous IE
Congenital heart disease (CHD)*
Unrepaired cyanotic CHD, including palliative shunts and conduits
Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure
Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
Cardiac transplantation recipients who develop cardiac valvulopathy