From the Guidelines
Yes, patients who have undergone Transcatheter Aortic Valve Replacement (TAVR) should still receive antibiotic prophylaxis before dental procedures, as they are considered to have a prosthetic cardiac valve, which places them at higher risk for developing infective endocarditis 1. The recommended regimen is typically amoxicillin 2g orally taken 30-60 minutes before the dental procedure for adults. For patients allergic to penicillin, alternatives include clindamycin 600mg, azithromycin 500mg, or clarithromycin 500mg orally. This recommendation applies to dental procedures that involve:
- Manipulation of gingival tissue
- Perforation of the oral mucosa
- Procedures involving the periapical region of teeth However, routine anesthetic injections through non-infected tissue, dental radiographs, placement of removable prosthodontic appliances, and orthodontic appliance adjustment do not require prophylaxis 1. Patients should inform their dentist about their TAVR procedure to ensure appropriate prophylaxis is provided, and they should also be encouraged to use optimal dental hygiene and see a dentist regularly for routine cleaning and dental care, with antibiotic prophylaxis at each visit. The purpose of antibiotic prophylaxis is to prevent bacteria that enter the bloodstream during dental procedures from colonizing the prosthetic valve and causing endocarditis, which can have severe consequences, including high morbidity and mortality rates 1.
From the Research
Dental Antibiotic Prophylaxis for TAVR Patients
- TAVR patients may still require dental antibiotic prophylaxis due to the risk of infective endocarditis (IE) [ 2, 3].
- A study found that 40% of IE cases are likely caused by oral bacteria, and the prevalence of IE after TAVR is comparable to that after surgical prosthetic valve replacement (SVR) [ 2 ].
- Another study reported that the incidence of IE after TAVR is highest during the early period, and Enterococcus species are the most frequently isolated microorganisms [ 3 ].
Periprocedural Antibiotic Regimens for TAVR
- There are no guidelines recommending a specific prophylactic antibiotic treatment for TAVR [ 4 ].
- A study compared the clinical data of TAVR patients receiving 1-day and 3-day Cefuroxime prophylaxis regimens, and found no significant difference in hospitalization duration, but a higher incidence of diarrhea and Clostridium difficile infections in the 3-day group [ 4 ].
- The study suggests that a shorter 1-day antibiotic regimen may be sufficient for TAVR patients [ 4 ].
Oral Health and Dental Findings in TAVR Candidates
- A study found that oral-dental findings were similar between TAVR and SVR candidates, and half of the patients in both groups required pre-procedural dental treatment [ 2 ].
- The study suggests that IE preventive oral-dental care may be justified in patients undergoing TAVR, especially those initially denied SVR due to prohibitive operative risk [ 2 ].