Infective endocarditis prophylaxis for dental procedures in 2009: what has changed?

T here is now evidence that most cases of infective endocarditis are not attributable to an invasive procedure, and bacteremia resulting from daily activities is much more likely to cause infective endocarditis than bacteremia associated with a dental procedure. Thus, the usefulness of antibiotic prophylaxis in this setting has been questioned. In the recently revised American Heart Association (AHA) guidelines, infective endocarditis prophylaxis is no longer mandatory, i.e. a Class I recommendation, in any patient, even in the presence of native valve disease. It should be given, as a Class IIA recommendation, in patients with prosthetic valves or a history of endocarditis only prior to dental procedures that involve manipulation in gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa. This review discusses the new guidelines and suggests recommendations for cardiac conditions about which data are virtually lacking.