The New Endocarditis Guideline: Which Dental Procedures Merit Prophylaxis?

The updated 2007 American Heart Association recommendations for endocarditis prophylaxis will dramatically reduce the number of patients with cardiac conditions for whom prophylactic antibiotics will be prescribed (Journal Watch Jun 12 2007). In a departure from the earlier guideline, the writers did not include a list of specific dental procedures for which prophylaxis is recommended. This change prompted one of my internal medicine colleagues to ask this question: “When patients call and ask us whether they need prophylaxis before upcoming dental visits, how do we decide?”

Her question arose because the 1997 version of the guideline included a table listing 8 specific dental procedures for which prophylaxis was indicated and 11 for which p…