Current Approaches to Antibiotic Prophylaxis for Infective Endocarditis in Pediatric Dentistry: A Review

Infective endocarditis (IE) is a serious, potentially life-threatening bacterial infection of the cardiac epithelium, with a mortality rate of 5% in children. The most common risk factor for IE in this population is congenital heart disease. The American Academy of Pediatric Dentistry recognizes that certain medical conditions increase susceptibility to infections from bacteremia. Antibiotic prophylaxis is advised for high-risk patients before procedures that could lead to bacteremia in order to reduce or prevent transient bacteremia resulting from invasive dental treatments. However, the effectiveness of this prophylaxis in preventing or reducing the frequency and severity of bacteremia associated with dental operations remains controversial. This review aims to discuss the current approaches to antibiotic prophylaxis in pediatric dentistry to prevent IE. While some studies suggest that pre-operative antibiotics reduce these factors, others find no such benefit. Given these uncertainties, maintaining good oral hygiene and treating dental diseases promptly are crucial for reducing the risk of bacteremia from everyday activities. In the past, patients with most types of congenital heart disease were prescribed antibiotics before dental procedures in accordance with American Heart Association recommendations. Today, however, antibiotics before dental operations are only recommended for patients with cardiac conditions that pose a high risk of infective endocarditis. The overall health of vulnerable pediatric patients can be enhanced by minimizing the risk of infective endocarditis through interdisciplinary collaboration, especially between pediatric cardiologists and dentists.