Oral Surgery · patient case question
She had tetralogy of Fallot repaired successfully in childhood with no residual defect. What is the recommendation regarding antibiotic prophylaxis?
Patient case: Extraction, infection and a difficult healing
demo: 44-year-old female
chief: Severe throbbing pain and a foul taste four days after an extraction, plus swelling from a separate upper tooth.
history: Osteoporosis treated with intravenous zoledronic acid for three years. She smokes. She had corrective surgery for tetralogy of Fallot in childhood with no residual defect.
meds: Zoledronic acid, calcium and vitamin D.
findings: The socket at site 32 is empty of clot with exposed bone and exquisite tenderness. There is no purulence. Separately, tooth 4 is grossly carious with vestibular swelling and tenderness.
Show answer and explanation
Correct answer: C. No prophylaxis is required beyond six months after the repair
- A. A prosthetic valve is a separate lifelong indication, but she does not have one.
- B. The indication is determined by the cardiac condition, not by the type of dental procedure, though the procedure must involve manipulation of gingival tissue or the periapical region or perforation of the mucosa.
- C. Correct. Under AHA guidance, completely repaired congenital heart disease with prosthetic material requires prophylaxis for the first six months only, the period of endothelialisation. After that, with no residual defect, prophylaxis is no longer indicated.
- D. Lifelong prophylaxis applies to unrepaired cyanotic congenital heart disease and to repairs with a residual defect at or adjacent to the prosthetic material.