How to prevent endocarditis during dental treatment?

Most cases of procedure-related endocarditis occur within 10 to 14 days of the procedure. Therefore, if you have symptoms beyond this time, you are unlikely to have endocarditis.


Endocarditis is the result of a bacterial infection. It is a rare and life-threatening condition that involves inflammation of the lining and valves of the heart muscle. Although endocarditis can occur in anyone, it is more common in people with heart disease and people who have had endocarditis before.

Possible symptoms of endocarditis include:

1) Unexplained fever

2) Chills at night

3) Weakness, muscle pain or joint pain

4) Apathy (lethargy) or malaise (general malaise)

Although the administration of antibiotics decreases the risk of endocarditis, it does not guarantee prevention. Most cases of procedure-related endocarditis occur within 10 to 14 days of the procedure. Therefore, if you have symptoms beyond this period, you are very unlikely to have endocarditis. Either way, it’s always wise to consult your doctor or dentist if you have any concerns.

The American Heart Association Endocarditis Committee published a set of guidelines initially in 1997 and then in 2007 to help prevent endocarditis. After reviewing several studies, the committee concluded that only a rare number of cases of infective endocarditis could be prevented by giving antibiotics before dental procedures. For cardiac patients and therefore at high risk of developing complications due to endocarditis, antibiotic treatment before dental procedures involving manipulation of the gums is a reasonable preventive measure.

In rare cases involving high-risk people, bacteria in the mouth can trigger endocarditis. Plaque found in dental plaque can cause gingivitis, which is inflammation of the gums. If left untreated, gingivitis can progress and cause the gums to become red, swollen, and bleed during brushing, flossing, or any dental procedure that involves manipulation of the gums. When the gums bleed, they give way to bacteria that enter the bloodstream and infect other parts of the body. In the case of endocarditis, it is the inner lining of the heart and the surfaces of its valves.

Because this event is so rare, the latest AHA guidelines suggest giving antibiotics before dental procedures only to patients most at risk of developing complications from endocarditis. The reason for this is that in most cases the risk associated with the use of antibiotics, i.e. the formation of blood clots, outweighs the prophylactic benefits.

Patients with certain heart conditions are advised to receive a single dose of an antibiotic at least one hour before specific dental procedures for prophylaxis. According to the American Heart Association and the American Dental Association, antibiotics should be given before dental treatment to patients with:

1) History of bacterial endocarditis

2) A prosthetic heart valve or prosthetic material used in valve repair

3) Heart valve disease and having undergone a heart transplant

4) Congenital heart disease

The new guidelines suggest preventive treatment before subsequent dental procedures.

1) Dental procedures with manipulation of gingival tissues

2) A perforated inner wall of the mouth

However, antibiotics are not recommended for the following dental procedures:

1) Routine anesthetic injections through uninfected tissue

2) Dental x-rays

3) Adjustment of orthodontic appliances

4) Placement of removable prosthetic or orthodontic appliances

5) Placement of orthodontic brackets

6) Bleeding from trauma inside the mouth or lips

7) Loss of baby teeth

If you notice a change in your state of health since your last visit, you must inform your dentist. Be sure to provide a detailed account of your medical history, especially if you have a history of heart or vascular surgery within the past six months and a diagnosis of any other heart disease. You should provide them with a list of all your medications and dosages, both prescription and over-the-counter. Provide your dentist with your doctor’s phone number if they wish to correspond with them regarding your dental care plan and medication choices. Practice good oral hygiene by brushing your teeth twice, flossing at least once, and using antiseptic mouthwash regularly. Good oral health is integral to patients at high risk for endocarditis.

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