Dental treatment and management of a patient with a prosthetic heart valve.

The American Heart Association committee recognizes that their regimens do not cover all situations. Each patient should be evaluated individually. The necessity for parenteral therapy or oral erythromycin to continue for 48 hours after all dental procedures should be reevaluated on a case-by-case basis. On the other hand, if the dental manipulation involves an infected site, perhaps antibiotic therapy should be continued until signs of the inflammation subside. Dentists and physicians must use their clinical judgement in prescribing antibiotics. However, as Kaye proposed, any deviation in prescribing antibiotics should be in the direction of higher doses or more effective antibiotics. In addition, practitioners must provide adequate patient education and follow-up. Unfortunately, a negligent dentist, a physician giving poor or inadequate advice, or a patient not following instructions may turn a simple dental procedure into a life-threatening situation and potential tragedy.