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Medically Compromised Patient Care

Course Number: 628

Cardiac Patients

Antibiotic pre-medication is required for cardiac conditions associated with high risk for developing infective endocarditis. There are five conditions associated with adverse outcomes for which prophylaxis for dental treatment is indicated:

  1. Prosthetic heart valve, which includes transcatheter-implanted prostheses and homografts.

  2. Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords.

  3. Previous history of infective endocarditis.

  4. Cardiac transplant with valve regurgitation due to a structurally abnormal valve.

  5. Congenital heart disease (CHD), or conditions which have been present since. Specifically, the following two CHD’s are a concern:

    1. Unrepaired cyanotic CHD, including palliative shunts and conduits

    2. Repaired CHD defect with residual shunts or valvular regurgitation at the site of, or adjacent to the site of, a prosthetic patch or a prosthetic device (Figure 2).8,9

ce628 - Figure 2

Table 2 provides questions that are helpful for oral health practitioners to ask when reviewing the medical history of patients suspected of having high risk cardiac conditions.

Table 1. Antibiotic Premedication Treatment Examples 1
These cases DO need antibiotic premed if there is manipulation of gingival tissue or periapical region of teeth, or perforation of oral mucosa, such as:These procedures are ok to perform WITHOUT antibiotic premed:
  • Biopsies
  • Suture removal
  • Placement of ortho bands
  • Root planing
  • Adult prophy
  • Filling or root canal
  • Injections through PDL (intraligamentary and intraosseous)
  • Routine anesthetic injections (nerve blocks and supraperiosteal) through non-infected tissue
  • Taking radiographs
  • Placement of removable appliances
  • Adjusting ortho appliances & placing orthodontic brackets
  • Shedding deciduous teeth

In summary, premedication is most often indicated in situations involving severe valvular conditions. These premedication requirements are standard protocol per the ADA and American Heart Association (AHA) and do not require a medical consult. However, congenital heart conditions will often times require a consult with the medical provider to determine specific antibiotic prophylactic needs.

ce628 - Reminder - 1