- Administer antibiotic according to the 2021 American Heart Association’s infective endocarditis prophylaxis guidelines. In general, antibiotic prophylaxis should be considered for dental procedures involving the gingival pocket or the periapical region of the teeth in patients with prosthetic valves, including transcatheter valves, or with repairs using prosthetic material.
- Be aware of possible drug allergies.
- Check the patient’s prothrombin time/international normalized ratio (PT/INR), when appropriate.
From Vahanian A, et al. below.
|Target international normalized ratio for mechanical prostheses|
|Prosthesis thrombogenicity||Patient-related risk factors: |
mitral or tricuspid valve replacement; previous thromboembolism;
atrial fibrillation; mitral stenosis; left ventricular ejection fraction <35%
|None||≥1 risk factor|
Carbomedics, Medtronic Hall, ATS,
St Jude Medical, Sorin Bicarbo
Other bileaflet valves
Starr-Edwards (ball-cage), Bjork-Shiley
and other tilting-disc valves
- Follow anticoagulation protocol for anticoagulated patients.
- Antiplatelet medications used for patients with prosthetic heart valves do not need to be altered prior to routine dental care.
| Drugs/ drug|
See Medical Complexity Status for more information.
- Medical Disorders
- Oral Health care Considerations
- Classifications and Definitions
- Lockhart PB, et al. Effect of dental treatment before cardiac valve surgery. Systematic review and meta-analysis. J Am Dent Assoc. 2019:150(9):739-747
- Sousa-Uva M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. European Journal of Cardio-Thoracic Surgery. 2018; 53(1):5–33.
- Vahanian A, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021(Aug 28);ehab395.