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1. THE NEED FOR ANTIBIOTIC
PROPHYLAXIS IN CLIENTS
WITH UNDERLYING CARDIAC
CONDITIONSLauren McMeekin, Valerie Cote & Morgan Milligan

2. PICO QUESTION
In clients with underlying heart conditions, does premedication
reduce the risk of infective endocarditis, compared to no
premedication during dental prophylaxis?
P = clients with underlying heart conditions
I = prophylaxis antibiotic
C = no prophylaxis antibiotic
O = reduction in infective endocarditis

3. WHAT IS
INFECTIVE
ENDOCARDITIS?
It is defined as an infection
caused by bacteria entering
the blood stream and
attaching itself to the heart
chamber linings (Chen, Tung,
Wu, 2015)
It is an inflammation of the
inner tissues of the heart, the
endocardium, usually of the
valves. It is caused by
infectious agents, or
pathogens, which are
largely bacterial but a few
other organisms can also be

4. VIDEO
https://www.youtube.com/watch?v=FDB0VDZxoNw

5. WHAT IS ANTIBIOTIC
PROPHYLAXIS?
An antibiotic given in order to prevent infection
complications prior to treatment. Bacteria is more
likely to enter the blood stream while at the dentist
and undergoing care. Antibiotic prophylaxis will
prevent any risk of developing infective endocarditis.
WHY?
Many dental clients often have underlying factors that
increase the chance of obtaining infective endocarditis
People with underlying cardiac conditions are the one’s that
require the premedication

6. GUIDELINES
The guidelines state that prophylactic antibiotics, which were
routinely administered to certain patients in the past, are no longer
needed for patients with:
mitral valve prolapse
rheumatic heart disease
bicuspid valve disease
calcified aortic stenosis
congenital heart conditions such as ventricular septal defect, atrial
septal defect and hypertrophic cardiomyopathy.
(Prevention of Enodcarditis, CDA,
2016)

7. UNDERLYING CONDITIONS
Some underlying conditions that require premedication's:
prosthetic cardiac valve or prosthetic material used for cardiac valve repair
history of infective endocarditis
cardiac transplants that develop cardiac valvulopathy
Congenital
unrepaired cyanotic congenital heart disease
palliative shunts and conduit a
completely repaired congenital heart defect with prosthetic material or device
any repaired congenital heart defect with residual defect at the site or adjacent to the site of a
prosthetic patch or a prosthetic device

8. NO ANTIBIOTIC PROPHYLAXIS?
Some studies have shown that not everyone with a heart condition
need to take a pre medication prior to invasive dental treatment
A study in Minnesota found that there was not a significant increase
in infective endocarditis within three months preceding dental
treatment, supports the fact that premedication is unnecessary for
dental prophylaxis (Wilson et al., 2008.)
ADA guidelines note that people with IE are exposed to the same
bacteria from daily oral hygiene routines.
Many forget to take it, or lie about taking it.
COUNTER
ARGRUMENT

9. OVER PRESCRIBING?
Due to over prescribing of antibiotics, there may be an increased
risk of antibiotic resistance in some individuals.
With all the different studies that have been done, there is no
significant proof that there is a need for an antibiotic prophylaxis in
certain cardiac cases.

10. DENTAL PROCEDURES THAT CONSIST
OF THE INVASION OF GINGIVAL TISSUE
Assessment; probing and exploration
Debridement, calculus and plaque removal
Polish, dental prophylaxis
All of which can induce perforation of the oral mucosa
All treatments that require a prophylaxis prior to treatment for any
client with an underlying cardiac condition (Wilson et al., 2008).
Invasive treatment creates blood which leads to bacteria getting into
the blood stream causing infection (Sroussi, Epstein, Prabhu, 2007).

11. CONT..
Taking antibiotic prophylaxis provides an extra
barrier to lower the risk of contracting infection.
Evidence shows that the risk may occur within two
weeks following that dental procedure, but with
many studies there has been evidence that the
infection can be caused by dental procedures
performed months earlier (Sroussi, Epstein,
Prabhu, 2007).

12. BEING AWARE AND UP TO DATE IS
KEY
Every dental practitioner must follow
most up to date standards in order to
provide the best care.
Following guidelines creates high
standards of care and defines
medicolegal standards (Sroussi, Epstein,
Prabhu, 2007).
Must always be taken seriously when a
client has a need for premedication

13. CONT..
Canadians can choose to follow the
American guidelines or a British society
guideline
Which ever one your office follows it must
always be followed to best standards

14. CONCLUSION
Client’s medical history must always be taken into consideration in
order to confirm if the client will require an antibiotic prophylaxis
Dental staff must always follow the prompt guidelines to ensure the
optimal care for clients
Take every precaution that is necessary
Essential for a client with an underlying cardiac condition
Antibiotic pre medication is still necessary for client that may be
susceptible to infective endocarditis

15. REFERENCES
American Dental Association. (2016, May). Retrieved from http://www.ada.org/en/member
center/oral- health-topics/antibiotic-prophylaxis
Chen, P., Tung, Y., Wu, P. W., Wu, L., Lin, Y., Chang, C.,…Chu, P. (2015). Medicine. Dental
Procedures and the Risk of Infective Endocarditis. 1-6. Retrieved from,
file:///C:/Users/Morgmill/Downloads/DentalProceduresandtheRiskofInfectie.41pf
Glasscoe, D.D. (n.d.). New Premedication Guidelines. Retrieved from,
http://www.rdhmag.com/articles/print/volume-28/issue-1/columns/staff-rx/new
premedication- guidelines.html
Sexton, D. J. (2016, June). Patient information: Antibiotics before procedures (Beyond the
Basics). Retrieved from http://www.uptodate.com/contents/antibiotic
beforeprocedures-beyond-the-basics
Sroussi, H. Y., Epstein, J. B., & Prabhu, A. R. (2007, June). Which Antibiotic Prophylaxis
Guidelines for Infective Endocarditis Should Canadian Dentists Follow?. Retrieved from,
https://www.cda-adc.ca/jcda/vol- 73/issue-5/401.pdf
Wilson, W., , Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison, M.,…Bolger,
A. (2008). Prevention of infective endocarditis: Guidelines from the American
Heart Association. JADA, Vol. 139 Retrieved from, http://jada.ada.org/article/S0002-
8177(14)627458/pdf