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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Dental Antibiotic Prophylaxis

The following cardiac conditions warrant infective endocarditis (IE) prophylaxis for some dental and surgical procedures:

  • Prosthetic cardiac valve or prosthetic material used for valve repair
  • Previous infective endocarditis
  • Congenital heart disease (CHD)
    • Unrepaired cyanotic CHD, including shunts and conduits
    • Completely repaired congenital heart defect with prosthetic material or device during the first 6 months after the procedure
    • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
  • Cardiac transplantation recipients who develop cardiac valvulopathy

Prophylaxis is recommended for all dental procedures involving manipulation of gingival tissue or periapical region of teeth or oral mucosa perforation.

Prophylaxis is NOT required for routine anesthetic injections, dental radiographs, placement of removable orthodontic appliances, adjustment of orthodontic appliances, placement of orthodontic brackets, shedding of deciduous teeth, and bleeding from trauma to the lips or oral mucosa. IE prevention standard prophylaxis is Amoxicillin 50 mg/kg (Maximum dose 2 grams) by mouth 1 hour prior to the dental procedure.

Fast Facts
First-line therapy for Subacute Bacterial Endocarditis is Amoxicillin.
Options for Penicillin-allergic patients include Clindamycin, cephalosporins, and macrolides.
The American Heart Association has recently revised the guidelines for cardiac lesions requiring prophylaxis.

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