Prevention of some cases of bacterial endocarditis is achieved by intelligent use of appropriate antibiotics on the day of dental or other surgery. Approximately 25% of cases of endocarditis are believed to be of dental origin and in approximately 75% of cases the portal of entry cannot be identified. In over 40% of cases infection occurs on valves not known to be abnormal, especially on bicuspid aortic valves and in patients with mitral valve prolapse. Except for prosthetic valves in which a powerful antibiotic regime is administered, prophylaxis is aimed at streptococci, which accounts for only about 65% of all cases of endocarditis.
The American Heart Association has guidelines for preventing bacterial endocarditis. Patients with valvular heart disease must be given antibiotics one hour prior to all dental or surgical procedures. The antibiotic is given orally for dental work done under local anesthetic. It is given intravenously for patients with prosthetic valves, patients with highest risk of developing endocarditis, or patients who are having a general anesthetic. All dental procedures that are likely to result in gingival bleeding such as extra¬ctions, root canal, scaling and cleaning, surgery in the oral cavity, biopsies, and many surgical operations and tests such as cystoscopy require antibiotic coverage to prevent endocarditis.

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