from the Journal of the American Medical Association

Poor dental hygiene and periodontal infections may produce bacteria even in the absence of dental procedures. Individuals who are at risk for developing bacterial endocarditis should establish and maintain the best possible oral health to reduce potential sources of bacterial seeding. Dentists should make every attempt to reduce gingival inflammation in patients who are at risk by means of brushing, flossing, fluoride rinse, chlorhexidine gluconate mouth rinse, and professional cleaning before proceeding with routine dental procedures.

bacterial endocarditis

Antibiotic prophylaxis is recommended with all dental procedures likely to cause gingival bleeding, including routine professional cleaning. If a series of dental procedures is required, it may be prudent to observe an interval of 7 days between procedures to reduce the potential for the emergence of resistant strains of organisms. If possible, a combination of procedures should be planned in the same period.

The recommended standard prophylastic regimen for all dental procedures is amoxicillin. The antibiotics amoxicillin, ampicillin, and pencillin V are equally effective in vitro against (infection). However, amoxicillin is now recommended because it is better absorbed from the gastrointestinal tract and provides higher and more sustained serum levels. The choice of penicillin V rather than amoxicillin as prophylaxis against (infection) is acceptable.

Individuals who are allergic to penicillins should be treated with erythromycin ethlsuccinate and erythromycin stearate because of more rapid and reliable absorption.