Dental Procedures and Endocarditis Prophylaxis

• Dental extractions
• Periodontal procedures including surgery, scaling, root planing, probing and recall maintenance
• Dental implant placement and reimplantation of avulsed teeth
• Endodontic (root canal) instrumentation or surgery only beyond the apex
• Subgingival placement of antibiotic fibers or strips
• Initial placement of orthodontic bands (but not brackets)
• Intraligamentary local anesthetic injections
• Prophylactic cleaning of teeth or implants, where bleeding is anticipated

• Restorative dentistry (operative and prosthodontic)² with or without retraction cord³
• Local anesthetic injections (nonintraligamentary)
• Intracanal endodontic treatment (post placement and buildup)
• Placement of rubber dams
• Postoperative suture removal
• Placement of removable prosthodontic or orthodontic appliances
• Oral impressions
• Fluoride treatments
• Oral radiographs
• Orthodontic appliance adjustment
• Shedding of primary teeth

1. Prophylaxis is recommended for patients with high-and moderate-risk cardiac conditions.
2. This includes restoration of decayed teeth (filling cavities) and replacement of missing teeth.
3. Clinical judgment may indicate antibiotic use in selected circumstances that may create significant bleeding.

Adapted from Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA. 1997;277:1794-1801. Copyrighted 1997, American Medical Association.