# A Review of Guidelines for Antibiotic Prophylaxis before Invasive Dental Treatments
## 2 Materials and Methods
### Review of Guidelines
#### 2.1.3 Guidelines for Antibiotic Prophylaxis Regimens
The need for antibiotic prophylaxis is to prevent the development of such conditions following invasive dental procedures carried out after starting these treatments. Several studies have linked endodontic infections with systemic diseases, including cardiovascular diseases [29]. This has raised concerns regarding the dental management of patients before undergoing cardiovascular surgery. Dental screening and management of oral infections such as caries, endodontic infections, periodontal infections and so forth, prior to any invasive cardiovascular procedure is controversial due to the available guidelines lacking detailed information in this regard [6]. However, several studies have indicated an extensive preoperative extra- and intraoral examination for the detection of any infection, overall assessment of oral hygiene and sensibility testing for every individual tooth along with radiographic examination for detection of any teeth with irreversible pulpitis, pulp necrosis, apical periodontitis, acute apical abscess and chronic apical abscess requiring endodontic treatment [30]. Available information from the American Heart Association or European Society of Cardiology does not specify how the dental screening should be carried out. These guidelines ignore the fact that it is often challenging to make an accurate diagnosis or a definite conclusion regarding the outcome of dental treatment [6]. Unfortunately, dentists are usually the last to be informed of the timing of the cardiac intervention, which makes it difficult to assess the outcome of the treatment [30]. As reported by the European Society of Endodontology, the favourable outcome of endodontic treatment could be assessed one year after the completion of root canal treatment. Favourable outcome is described as the patient being asymptomatic, the absence of swelling and sinus tracts, functional teeth and radiological evidence of normal periodontal ligament space around the root [31]. If the lesion does not resolve in one year, further review appointments should be considered up to four years. However, if after four years the lesion persists, root canal treatment is considered to have an unfavourable outcome [31]. In a recent consensus report which included cardiologists, endodontists and periodontitis, it was concluded that to assess the outcome of endodontic treatment in cases of irreversible pulpitis, pulp necrosis, apical periodontitis, acute apical abscess and chronic apical abscess, follow-up time requires ranges from one week for the patient's symptoms up to one year for radiographic evaluation. The consensus stressed the need for the development of a protocol to aid both cardiologists and dentists during the perioperative preparation phase [30]. Furthermore, in a recent study done to analyse the attitude of cardiologists and cardiovascular surgeons towards the management of endodontic infections and oral health, cardiologists believed that the cardiac health of patients with heart diseases along with endodontic infections could be negatively affected by chronic root canal infection; also, most cardiac specialists emphasised the importance of managing endodontic diseases [32].