# A Review of Guidelines for Antibiotic Prophylaxis before Invasive Dental Treatments
## 2 Materials and Methods
### Review of Guidelines
Although these guidelines accept that the evidence base is weak and that an adverse drug reaction risk is present, the rationale for this recommendation is based on the fact that high-risk individuals are more likely to have a poorer outcome from an infective endocarditis event. The conditions associated with high-risk cardiac patients according to the NICE, SDCEP, ESC, AHA and KCE report 332 guidelines are summarised in Table 3.  
The NICE guidelines do not recommend antibiotic prophylaxis for the majority of high-risk patients undergoing routine dental procedures. The SDCEP recommends that  
\begin{table}
\begin{tabular}{c c} \hline \hline \multicolumn{2}{c}{**Conditions**} \\ \hline \multicolumn{2}{c}{Special considerations subgroup} \\
1. & The use of a prosthetic valve, such as transcatheter valve, or valve repair with any prosthetic material \\
2. & History of infective endocarditis \\
3. & Congenital heart defects (CHD) \\
4. & Cyanic CHD “any type” \\
5. & CHD repaired with a prosthetic material, using either surgical or percutaneous techniques, for 6 months following the procedure or lifelong if residual shunt or valvular regurgitation  
cardiac patients from the \"special considerations subgroup\" (Table 3) may require antibiotic prophylaxis for nonroutine dental management and this should be assessed in consultation with their cardiologists. The AHA, ESC and KCE support antibiotic prophylaxis for their enlisted high-risk cardiac patients (Table 3). Thus, the variations in these recommendations suggest the need for globally accepted consensus guidelines to prevent any confusion among healthcare providers and patients. 1.2 Antibiotic Prophylaxis Guidelines against Infection in Patients with Immunosuppressive Conditions Undergoing Endodontic Treatment  
Along with cardiovascular diseases, immunosuppressive conditions have also been indicated for antibiotic prophylaxis. Patients with impaired immune response could encounter complications following dental treatment, such as spread of infection. Both nonsurgical root canal treatment and endodontic surgery can initiate detectable bacteriaemia. It is well documented that the incidence of bacteria following root canal treatment and endodontic surgery is up to 20% [23] and 83.3%, respectively [24]. The European Society of Endodontology (ESE) published a position statement on antibiotics in endodontics. Along with cardiac conditions, the authors also mentioned a list of other conditions, including impaired immunologic function, prosthetic joint replacement, high-dose irradiation of jaws and intravenous bisphosphonates, where prophylactic antibiotics are indicated for patients having certain endodontic treatment procedures [25] (Table 4). The abovementioned patient groups, either due to their immune deficiency or decreased tendency of wound healing, are more prone to infections and are thus indicated for antibiotic prophylaxis in endodontics according to the ESE. Recently, the American Dental Association (ADA) published guidelines on the use of antibiotics for emergency handling of pulpal and periapical dental pain and oral swelling. They concluded that antibiotics are not recommended in fit and healthy adults diagnosed with symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, but they advised that those patients should be referred for definitive dental treatment. When dental treatment is not feasible and patients' symptoms get worse, a delayed prescription for amoxicillin or penicillin V potassium administered orally for patients diagnosed with pulp necrosis and symptomatic apical periodontitis is recommended. On the contrary, the expert panel suggested the pre