TAVR Dental Prophylaxis Recommendations
Patients who have undergone TAVR require antibiotic prophylaxis for dental procedures according to AHA/ACC guidelines for prosthetic heart valves, along with optimal dental hygiene maintenance. 1, 2
Antibiotic Prophylaxis Requirements
All TAVR patients need standard endocarditis prophylaxis for dental procedures as they have prosthetic cardiac valves, which places them in the highest risk category for infective endocarditis. 2 The 2017 ACC Expert Consensus specifically states that antibiotic prophylaxis should follow AHA/ACC guidelines for all prosthetic valves. 1
Key Clinical Context
- TAVR patients are managed identically to surgical valve replacement (SAVR) patients regarding endocarditis prophylaxis 1
- Approximately 40% of infective endocarditis cases are caused by oral bacteria 3
- IE prevalence after TAVR is comparable to IE following surgical prosthetic valve replacement 3
- The risk persists lifelong as the prosthetic valve remains a permanent nidus for potential infection 2
Dental Care Strategy
Preventive Dental Management
Optimal dental hygiene and regular dental visits for routine cleaning should be strongly encouraged in all TAVR patients. 1, 2 This preventive approach is critical because:
- Good oro-dental hygiene reduces the bacterial load that can cause transient bacteremia during eating and tooth brushing 4
- Regular professional dental care minimizes the need for more invasive procedures that carry higher bacteremia risk 4
Pre-Procedural Dental Screening
Consider comprehensive dental screening and treatment of active dental disease before TAVR when feasible, similar to the approach used for surgical valve candidates. 3 Research demonstrates that:
- Oral health findings requiring pre-procedural dental treatment are similar between TAVR and surgical valve candidates (approximately 50% in both groups) 3
- Despite TAVR patients being significantly older (mean age 81 vs 66 years), their dental pathology burden is comparable to surgical candidates 3
- Pre-procedural dental treatment appears justified for IE prevention 3
Important Clinical Pitfalls
Do not assume TAVR patients need less rigorous endocarditis prophylaxis than surgical valve patients - they carry equivalent risk and require identical prophylactic measures. 2, 3 The transcatheter approach does not reduce the prosthetic valve infection risk compared to surgical implantation.
Ensure coordination between the TAVR team, primary cardiologist, and dental providers regarding prophylaxis protocols, as readmission rates exceed 40% in the first year after TAVR, with infections being a common cause. 1, 2