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

Infective endocarditis (IE) is a serious and potentially life-threatening bacterial infection of the cardiac epithelium, with a mortality rate of approximately 5% in children. The most common risk factor for IE in this population is congenital heart disease. The American Academy of Pediatric Dentistry acknowledges that certain medical conditions increase susceptibility to infections resulting from bacteremia. Antibiotic prophylaxis is recommended for high-risk patients prior to procedures that could induce bacteremia, with the goal of reducing or preventing transient bacteremia caused by invasive dental treatments. However, the effectiveness of prophylaxis in preventing or mitigating the frequency and severity of bacteremia associated with dental procedures remains controversial. This review explores current approaches to antibiotic prophylaxis in pediatric dentistry for the prevention of IE. While some studies suggest that preoperative antibiotics reduce these risks, others report no significant benefit. Given these uncertainties, maintaining good oral hygiene and promptly treating dental diseases are essential strategies to reduce the risk of bacteremia from routine daily activities. Historically, patients with most forms of congenital heart disease were prescribed antibiotics prior to dental procedures in line with American Heart Association guidelines. Today, however, antibiotics before dental procedures are recommended only for patients with cardiac conditions that pose a high risk for infective endocarditis. The overall health of vulnerable pediatric patients can be improved by reducing the risk of infective endocarditis through interdisciplinary collaboration, particularly between pediatric cardiologists and dentists.