We have vigorously pursued antibiotic remediation, and the unindicated prophylactic application of antibiotics is strictly prohibited. However, it is not too late, and certain cardiac patients have clear indications for prophylactic application of antibiotics when receiving oral therapy to avoid infective endocarditis. The 2014 AHA/ACC guidelines for the management of valvular disease state that: recommendation level: Class
IIa: It is reasonable to give prophylactic treatment for infective endocarditis in the following high-risk groups when dentistry operations involve the gums, roots, or disruption of the oral mucosa Patients with prosthetic heart valve replacement; Patients with a history of infective endocarditis; Heart transplant recipients with valve regurgitation; Patients with uncorrected cyanotic predilection; Patients with predilection in the presence of palliative shunts or artificial conduits; Patients with predilection in which artificial material has been applied within 6 months for repair or sealing; Patients with residual shunts at or near the artificial material after corrective surgery for predilection.