Terms in this set (32)

Answer: Initial placement of the orthodontic bands. According to the ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis, prophylaxis prior to dental procedures is now indicated only for patients with specific highest-risk-for-IE cardiac conditions:
• Prosthetic valves (bioprosthetic or mechanical)
• Previous episode of endocarditis
• Congenital heart disease (CHD)
◦ Unrepaired cyanotic CHD
◦ Repaired CHD within 6 months of procedure
◦ Repaired CHD with residual defects
• Cardiac transplant patients with valve lesions
Prophylaxis is no longer indicated for bicuspid aortic valve, any ASD or VSD (unless unrepaired and cyanotic, or repaired with residual defect), native valvular stenosis or regurgitation, mitral valve prolapse (with or without murmur), coronary artery bypass graft (CABG), or HCM (unless repair occurs within 6 months of procedure).

Regarding dental procedures in these patients with highest-risk-for-IE conditions, antibiotic prophylaxis is given only for dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. This includes the initial placement of orthodontics bands but not the subsequent periodic adjustments. Oral suture removal does not require antibiotic prophylaxis.

Board Testing Point: Only area patients with the highest risk for of adverse outcomes with IE are prophylaxed for specific dental procedures—those that have significant gum manipulation or bleeding require antibiotic prophylaxis.