When did the guidelines for dental prophylaxis with antibiotics change and what are the indications for antibiotic prophylaxis (Antibiotic Prophylaxis) for dental procedures?

From the Guidelines

The guidelines for dental antibiotic prophylaxis changed in 2007, and currently, antibiotic prophylaxis before dental procedures is recommended only for patients with the highest risk of adverse outcomes from infective endocarditis, including those with prosthetic cardiac valves, previous infective endocarditis, certain congenital heart defects, and cardiac transplant recipients who develop cardiac valvulopathy. The reasons a person might need antibiotic prophylaxis for dental procedures are to prevent infective endocarditis in high-risk patients, and the standard regimen for adults is amoxicillin 2g orally taken 30-60 minutes before the procedure 1.

Key Points

• The American Heart Association substantially narrowed the recommendations for antibiotic prophylaxis in 2007 1.
• High-risk conditions that require antibiotic prophylaxis include prosthetic cardiac valves, previous infective endocarditis, certain congenital heart defects, and cardiac transplant recipients who develop cardiac valvulopathy 1.
• Dental procedures that typically require prophylaxis in high-risk patients include those involving manipulation of gingival tissue, perforation of oral mucosa, or procedures in infected sites 1.
• The risks of antibiotic use, including adverse reactions and antibiotic resistance, were determined to outweigh the benefits for most patients 1.

Recommendations

• Antibiotic prophylaxis should only be considered for dental procedures requiring manipulation of the gingival or periapical region of the teeth or perforation of the oral mucosa 1.
• Antibiotic prophylaxis is not recommended for local anaesthetic injections in non-infected tissues, treatment of superficial caries, removal of sutures, dental X-rays, placement or adjustment of removable prosthodontic or orthodontic appliances or braces, or following the shedding of deciduous teeth or trauma to the lips and oral mucosa 1.
• Other procedures, such as respiratory tract procedures, including bronchoscopy or laryngoscopy, transnasal or endotracheal intubation, gastroscopy, colonoscopy, cystoscopy, vaginal or caesarean delivery, TOE or skin and soft tissue procedures, do not require antibiotic prophylaxis 1.

From the Research

Guidelines for Dental Prophylaxis of Antibiotics

• The guidelines for dental prophylaxis of antibiotics have undergone changes over the years, with the American Heart Association (AHA) publishing revised guidelines in 2007 2.
• The 2007 AHA guidelines called for a major reduction in the number of patients recommended for antibiotic prophylaxis (AP) and redefined the dental procedures considered to put these patients at risk of acquiring infective endocarditis (IE) 3, 2.
• The guidelines have been updated to reflect that patients with underlying cardiac conditions, such as prosthetic heart valves, are at a higher risk of developing IE and should receive prophylaxis prior to dental procedures 2, 4.

Reasons for Antibiotic Prophylaxis

• Patients with a history of infective endocarditis, cardiac valves repaired with prosthetic materials, or animal/donor tissue may require antibiotic prophylaxis for dental procedures 5, 2.
• Patients with prosthetic joint replacements may also require antibiotic prophylaxis, although the guidelines for this are less clear-cut and may vary depending on the individual patient's risk factors 5, 3.
• The use of antibiotic prophylaxis is generally recommended for patients who are at a high risk of developing IE, such as those with certain types of congenital heart disease or those who have had previous episodes of IE 2, 4.
• Maintenance of oral health is also an important factor in reducing the risk of IE, and may be more effective than prophylactic antibiotics for dental procedures in some cases 2.