A child with tetralogy of Fallot that was surgically repaired without residual defects presents for restorative treatment. What is the MOST appropriate first step?

Correct answer: B. Consult the pediatric cardiologist to confirm the current repair status and prophylaxis requirement

• A. A pediatric dentist referral addresses behavior/age management, not the medical clearance question being asked.
• B. CORRECT. AHA guidelines require antibiotic prophylaxis for cyanotic congenital heart disease that is UNREPAIRED, for the first 6 MONTHS after repair with prosthetic material, and indefinitely if there is a RESIDUAL DEFECT at or adjacent to a prosthetic patch or device. Whether a specific repaired tetralogy patient still falls in a covered category is a cardiology determination — so the correct dental step is to obtain the cardiologist's written consult before deciding.
• C. Lifelong prophylaxis is NOT indicated for a fully repaired defect with no residual shunt after the 6-month endothelialization window.
• D. Proceeding without clarification risks missing a residual defect that would require coverage.

Note: Tetralogy of Fallot = the classic cyanotic CHD. The exam answer is almost always 'consult the cardiologist' when repair status is unclear.