Prophylaxis of infective endocarditis in dental practice – contemporary views

Matylda Trusewicz, Katarzyna Syguda-Chudzińska, Maja Bendyk-Szeffer, Piotr Makowiecki, Jadwiga Buczkowska-Radlińska


Infective endocarditis (IE) is generally caused by bacteria. The disease is associated with high mortality and significant risk of complications. Antibiotic prophylaxis should be used in patients at the highest risk of IE before procedures involving a high risk of bacteriemia – before dental procedures requiring manipulation of the gingival or periapical region of the teeth or perforation of oral mucosa.

The aim of this paper was to present the newest views and guidelines of Cardiology Societies on the management of patients with infective endocarditis in dental practice.

In 2015 experts of the European Society of Cardiology emphasized that the risk of IE caused by microflora of the oral cavity is higher due to bacteriemia caused by routine daily activities, i.e. mastication and brushing teeth, rather than due to bacteriemia caused by dental procedures. Poor oral hygiene, caries and gingival inflammation increase the risk of bacteriemia associated with routine activities. Emphasis should be put on improving dental care, systematic dental appointments, regular treatment, and maintaining optimal oral hygiene. These non-specific methods should be applied in patients at risk of IE, and should be extended to all patients, because IE can occur in patients without a history of heart disease. Antibiotic prophylaxis should be limited to patients at highest risk of IE: patients in whom an artificial heart valve or artificial repair material was grafted, patients with a previous episode of IE, patients with cyanotic heart disease, and patients with congenital heart disease repaired using prosthetic materials placed surgically or by percutaneous techniques.



infective endocarditis; antibiotic prophylaxis; dental procedures

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