What clinical circumstances should be considered when deciding whether endocarditis prophylaxis is required for dental care in children?

Updated: Jun 01, 2020
  • Author: Samah Alasrawi, MD; Chief Editor: Buck Christensen  more...
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The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use.

As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner’s professional judgment in consultation with the patient’s physician, along with the patient’s needs and preferences. [5]

These considerations include, but are not limited to, the following:

  • Patients with previous late artificial joint infection
  • Increased morbidity associated with joint surgery (wound drainage/hematoma)
  • Patients undergoing treatment for severe and spreading oral infections (cellulitis)
  • Patients with increased susceptibility to systemic infection
  • Congenital or acquired immunodeficiency
  • Patients on immunosuppressive medications
  • Patients with diabetes who have poor glycemic control
  • Patients with systemic immunocompromising disorders (eg, rheumatoid arthritis, lupus erythematosus)
  • Patients in whom extensive and invasive procedures are planned
  • Prior to surgical procedures in patients at significant risk for medication-related jaw osteonecrosis of the jaw [5]

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