Infective Endocarditis

The Need for Antibiotic Prophylaxis in Clients with Underlying Cardiac

Conditions

EVBP 5500
July 29th, 2016
Carrie Maynard
Lauren McMeekin, Valerie Cote & Morgan Milligan

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Infective Endocarditis

Infective endocarditis is a common health risk associated with underlying cardiac

conditions, during dental prophylaxis. It is defined as an infection caused by bacteria
entering the blood stream and attaching itself to the heart chamber linings (Chen, Tung,
Wu, 2015). Many dental clients often have factors that increase their chances of obtaining
infective endocarditis. As a client with a heart condition, taking a premedication as a
precaution decreases the likelihood of acquiring this condition. Although, it has been
shown in various studies that it is not necessary for patients with this heart condition to
take premedication preceding a dental appointment, it has been discovered that it is
effective in reducing the risk of gaining this infection. As a result, taking a premedication
prior to a dental procedure is beneficial for clients with underlying cardiac conditions
caused by infective endocarditis
Studies have shown that not everyone with a heart condition must take a pre
medication prior to dental treatment. A study in Minnesota found that there was not a
significant increase in infective endocarditis within three months preceding dental
treatment, supports the fact that premedication is unnecessary for dental prophylaxis
(Wilson et al., 2008.). American Dental Association Guidelines note that people who are
at risk for infective endocarditis are regularly exposed to bacteria during basic daily oral
hygiene routines such as brushing and flossing, demonstrating that bacteria disrupted in
the oral cavity on a regular basis, not only during dental prophylaxis. A case control study
was conducted at the University of Pennsylvania that compared the relationship between
previous dental work preformed on 273 adults with infective endocarditis and a control
group of equal size, it was established that dental procedures were not a risk factor
(Glasscoe, n.d.). Due to over prescribing of antibiotics, there may be an increased risk of

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antibiotic resistance in some individuals. With all the different studies that have been
done, there is no significant proof that the is a need for an antibiotic prophylaxis in
certain cardiac cases.
Clients with an underlying cardiac condition linked with a high risk of contracting
infective endocarditis, should take an antibiotic prophylaxis prior to dental treatment
(Wilson et al., 2008). Many clients have underlying cardiac conditions that should be
taken with the upmost seriousness. Some of the underlying conditions include prosthetic
cardiac valve or prosthetic material used for cardiac valve repair, history of infective
endocarditis, and cardiac transplants that develop cardiac valvulopathy. We must also
look at clients with congenital heart disease such as, unrepaired cyanotic congenital heart
disease, including palliative shunts and conduits, a completely repaired congenital heart
defect with prosthetic material or device, whether placed by surgery or by catheter
intervention, any repaired congenital heart defect with residual defect at the site or
adjacent to the site of a prosthetic patch or a prosthetic device (American Dental
Association, 2016). Based on the American Dental Association guidelines, these
underlying conditions may cause a client that has had intrusive dental treatment to have a
higher risk of getting infective endocarditis. All of these conditions require the client to
take a prophylaxis prior to dental procedures in order to prevent the adverse outcome of
them receiving infective endocarditis.
Dental procedures that consist of the invasion of gingival tissue or the periapical
region of the teeth or perforation of the oral mucosa, are all treatments that require a
prophylaxis prior to treatment for any client with an underlying cardiac condition (Wilson
et al., 2008). With dental procedures that are invasive it is important that the client with

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underlying cardiac conditions take an antibiotic prophylaxis prior to the dental

procedures. Bleeding occurs with intrusive dental treatment and this often leads to
bacteria getting into the bloodstream causing infection (Sroussi, Epstein, Prabhu, 2007).
This means that the clients that have an intrusive dental procedure done have a higher
risk of being infected. Some evidence shows that the risk may occur within two weeks
following that dental procedure, but with many studies there has been evidence that the
infection can be caused by dental procedures performed months earlier (Sroussi, Epstein,
Prabhu, 2007). The reason for the client taking an antibiotic prophylaxis prior to the
intrusive dental treatment, just provide an extra barrier so that the client has a lower risk
of contracting the infection.
Every dental practitioner must follow the most up to date standards of care in order to
provide the best care for their clients. Following the guidelines for infectious endocarditis
and the need for antibiotic prophylaxis in clients with an underlying cardiac condition
creates high standards of care and defines medicolegal standards (Sroussi, Epstein,
Prabhu, 2007). When a client has an underlying cardiac condition, the need for
prophylaxis and the necessity of the procedure should always be taken extremely serious
(Sroussi, Epstein, Prabhu, 2007). Though the guidelines have changed with time it is
important to keep up to date as more information has became available for practitioners
to know the severity a client with heart conditions has when it comes to dental procedures
(Sexton, 2016). The more up to date the practitioner is with the guidelines the safer the
client is in order to prevent infective endocarditis. Canadians can choose to follow the
American guidelines or a British society guideline, but nonetheless whichever you are

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expected to follow must be taken seriously and the guidelines followed accurately
(Sroussi, Epstein, Prabhu, 2007).
Overall, the clients medical history must always be taken into consideration in
order to confirm if the client will require an antibiotic prophylaxis. Dental staff must
always follow the prompt guidelines to ensure the optimal care for clients and to take
every precaution that is necessary. The need for premedication is essential for a client
with an underlying cardiac condition whether it may be congenital or not. This means that
the need for antibiotic pre medication is still necessary to an extent and it must be
enforced in order to provide the best care for every client that may be susceptible to
infective endocarditis.

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References
American Dental Association. (2016, May). Retrieved from
http://www.ada.org/en/member center/oral-health-topics/antibiotic-prophylaxis
Chen, P., Tung, Y., Wu, P. W., Wu, L., Lin, Y., Chang, C.,Chu, P. (2015). Medicine.
Dental Procedures and the Risk of Infective Endocarditis. 1-6. Retrieved from,
file:///C:/Users/Morgmill/Downloads/DentalProceduresandtheRiskofInfectie.41p
f
Glasscoe, D.D. (n.d.). New Premedication Guidelines. Retrieved from,
http://www.rdhmag.com/articles/print/volume-28/issue-1/columns/staff-rx/new
premedication-guidelines.html
Sexton, D. J. (2016, June). Patient information: Antibiotics before procedures (Beyond
the Basics). Retrieved from http://www.uptodate.com/contents/antibiotic before
procedures-beyond-the-basics
Sroussi, H. Y., Epstein, J. B., & Prabhu, A. R. (2007, June). Which Antibiotic
Prophylaxis Guidelines for Infective Endocarditis Should Canadian Dentists
Follow?. Retrieved from, https://www.cda-adc.ca/jcda/vol-73/issue-5/401.pdf
Wilson, W., , Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison,
M.,Bolger, A. (2008). Prevention of infective endocarditis: Guidelines from the
American Heart Association. JADA, Vol. 139 Retrieved from,
http://jada.ada.org/article/S0002-8177(14)627458/pdf

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