Infective Endocarditis

Infective endocarditis (IE), also called bacterial endocarditis, is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. IE is uncommon, but people with some heart conditions have a greater risk of developing it.

Risk factors for developing IE include:   

• Heart valve disease
• Previous heart valve surgery
• Congenital heart disease
• Intravenous drug use
• Previous history of IE

View an illustration of endocarditis.

Dental Procedures and Infective Endocarditis

People with the highest risk for poor outcomes from IE may be prescribed antibiotics (IE prophylaxis) prior to certain dental procedures to reduce their risk of developing it. These include procedures that involve manipulation of gingival (gum) tissue or the periapical region (area around the roots) of teeth, or perforation of the oral mucosa.

Antibiotic prophylaxis is reasonable before the above-mentioned dental procedures for people with heart valve disease who have any of the following:

1. Prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts.
2. Prosthetic material used for heart valve repair, such as annuloplasty rings, chords or clips.
3. Previous IE.
4. Unrepaired cyanotic congenital heart defect (birth defects with oxygen levels lower than normal) or repaired congenital heart defect, with residual shunts or valvular regurgitation at the site adjacent to the site of a prosthetic patch or prosthetic device.
5. Cardiac transplant with valve regurgitation due to a structurally abnormal valve.

Except for the conditions listed above, antibiotic prophylaxis before dental procedures is not recommended for any other types of congenital heart disease.

In addition, antibiotic prophylaxis is not recommended for patients with valvular heart disease who are at high risk of IE for nondental procedures (e.g., TEE, esophagogastroduodenoscopy, colonoscopy, or cystoscopy) in the absence of active infection. 

You can reduce the risk of IE by maintaining good oral health through regular professional dental care and the use of dental products such as manual, powered and ultrasonic toothbrushes; dental floss; and other plaque-removal devices. 

If you meet the requirements for antibiotic prophylaxis for dental treatment or oral surgery, your cardiologist or other health care professional may give you an American Heart Association wallet card (PDF). Show this card to your dentist, pediatrician, family doctor or other health care professional. It recommends the type of antibiotic and dose for IE prophylaxis. For smaller children, the dose will vary according to the child's weight. Always remind your dentist or doctor if you (or your child) are allergic to any antibiotics or other medications. 

Your health care team can provide you more information and answer your questions about preventing IE. 

• Print our patient information sheet What Is Endocarditis? (PDF) | Spanish (PDF)
• Print your own Prevention of Infective Endocarditis Wallet Card (PDF) | Spanish (PDF)