Ovidental Editorial Team
hola@ovidentalgo.com
Antibiotic prophylaxis plays a crucial role in preventing infective endocarditis (IE) in high-risk patients.
While indiscriminate use of antibiotics is discouraged due to the risk of bacterial resistance, current guidelines provide clear indications for their use in dental settings.
When is Antibiotic Prophylaxis Indicated in Dentistry?
According to the American Heart Association (AHA, 2021) and the European Society of Cardiology (ESC, 2023), antibiotic prophylaxis is recommended for high-risk patients undergoing dental procedures that involve gingival tissue manipulation, mucosal perforation, or periapical intervention.
High-Risk Patients
Antibiotic prophylaxis is still recommended for patients with:
✅ Prosthetic heart valves or prosthetic material used in valve repair.
✅ Previous history of infective endocarditis.
✅ Unrepaired congenital heart disease or repaired with prosthetic material within the last 6 months.
✅ Heart transplant with valve dysfunction.
Dental Procedures Requiring Prophylaxis
🔹 Tooth extractions.
🔹 Periodontal surgery.
🔹 Endodontic procedures that extend beyond the apex.
🔹 Dental implants with bone manipulation.
🔹 Prophylaxis in patients with gingival bleeding.
🔹 Any procedure involving incision or suturing of oral mucosa.
Recommended Antibiotics and Dosages
The AHA and ESC provide the following antibiotic prophylaxis recommendations for dental procedures:
✅ First choice (oral)
- Amoxicillin 2 g (adults) or 50 mg/kg (children) 1 hour before the procedure
✅ If the patient is allergic to penicillin
- Clindamycin 600 mg (adults) or 20 mg/kg (children)
- Azithromycin or Clarithromycin 500 mg (adults) or 15 mg/kg (children)
- Cephalexin 2 g (adults) or 50 mg/kg (children) (not for patients with anaphylaxis to beta-lactams)
✅ If the patient cannot take oral antibiotics
- Ampicillin 2 g IV or IM
- Cefazolin or Ceftriaxone 1 g IV or IM
Note: Administration should be a single dose, 30 to 60 minutes before the dental procedure.
► Important reading: Gingipains: The Oral Bacterial Toxins That Could Harm Your Brain
Importance of Antibiotic Prophylaxis in Dentistry
📌 Prevents life-threatening complications
Infective endocarditis has a high morbidity and mortality rate. Antibiotic prophylaxis significantly reduces the incidence in high-risk patients.
📌 Minimizes transient bacteremia
During invasive dental procedures, bacteria such as Streptococcus viridans can enter the bloodstream. Prophylaxis helps prevent colonization on heart valves.
📌 Encourages rational antibiotic use
Guidelines emphasize selective use for high-risk patients, avoiding unnecessary prescriptions and reducing bacterial resistance.
Conclusion
Antibiotic prophylaxis in dentistry remains a key recommendation for preventing infective endocarditis in high-risk patients.
Its application should be based on an individual patient assessment and the nature of the dental procedure.
Dentists play a crucial role in identifying patients who require prophylaxis and ensuring correct antibiotic administration.
Recent Scientific References
* Habib G, Lancellotti P, Antunes MJ, et al. 2023 ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2023;44(3):237-292. DOI:10.1093/eurheartj/ehz455
* Wilson W, Taubert KA, Gewitz M, et al. Prevention of Infective Endocarditis: Guidelines from the American Heart Association. Circulation. 2021;125(3):454-466. DOI:10.1161/CIRCULATIONAHA.106.183095
* Martin H. Thornhill, Teresa B. Gibson, Frank Yoon, Mark J. Dayer, Bernard D. Prendergast, Peter B. Lockhart, Patrick T. O’Gara, and Larry M. Baddour. Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures. JACC. 2022 Sep, 80 (11) 1029–1041.
