The American Heart Association (AHA) guidelines, last updated in 2017, recommend antibiotic prophylaxis for select patients with underlying cardiac conditions undergoing dental procedures that involve manipulation of the gingival tissue or periapical region of the teeth or perforation of the oral mucosa.

Key points from the guidelines include:

1. Antibiotic prophylaxis is recommended for patients with the highest risk of adverse outcomes from IE. This includes those with prosthetic cardiac valves, previous history of IE, certain congenital heart diseases (such as cyanotic congenital heart disease), and cardiac transplant recipients with cardiac valvulopathy.
2. Prophylaxis is no longer recommended for all patients with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, or calcified aortic stenosis unless they also have one of the conditions listed above.
3. For those who require prophylaxis, the recommended regimen is typically a single dose of an antibiotic taken orally one hour before the dental procedure. Commonly used antibiotics include amoxicillin, cephalexin, or clindamycin, depending on patient allergies and antibiotic resistance patterns.
4. Dental procedures that may require prophylaxis include dental extractions, periodontal procedures (including scaling and root planing), dental implant placement, and other invasive procedures involving manipulation of the gingival tissue or periapical region of teeth.
5. Routine antibiotic prophylaxis is not recommended for patients undergoing routine dental cleanings, routine restorative dentistry (e.g., fillings), orthodontic procedures, or removal of non-infected sutures.
6. It's essential for clinicians to review the patient's medical history, including any history of adverse reactions to antibiotics, to determine the most appropriate prophylactic regimen.
7. The guidelines emphasize that good oral health and hygiene practices, including regular dental examinations and prompt treatment of dental infections, are crucial for reducing the risk of IE.

It's important to note that these guidelines are subject to periodic review and update, so clinicians should stay informed about the latest recommendations from relevant professional organizations, such as the AHA or local dental associations. Additionally, individual patient factors and preferences should always be considered when making decisions about antibiotic prophylaxis for dental procedures.

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