According to newly released (4/19/07) revised guidelines from the AHA, with input from the ADA, antibiotic premedication is no longer indicated for dental patients with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, or congenital heart conditions such as ventricular septal defects, atrial septal defects, and hypertrophic cardiomyopathy.6
Antibiotic premedication remains recommended for patients at greatest risk of high-morbidity outcomes from IE. This includes patients with the following:
artificial heart valves
a history of IE
certain specific, serious congenital heart conditions:
unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits;
a 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;
any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device;
a cardiac transplant that develops a problem in a heart valve.
The new recommendations apply to dental procedures ranging from prophylaxis to extractions. The guidelines note that maintaining optimal oral health, including thorough daily oral hygiene, is more important in reducing the risk of IE than is taking preventive antibiotics before a dental visit. Additional information is available at ada.org
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