The first step in considering antibiotic prophylaxis for infectious endocarditis is identification of orthodontic patients at increased risk, using a questionnaire. In ‘at risk’ patients, antibiotics should be used for banding and dental prophylaxis but not for bracket placement or wire adjustment. Impressions and placement of removable appliances are considered as low risk procedures and do not require antibiotic prophylaxis on contrary to dental extractions. Exfoliation of primary teeth does not require antibiotic prophylaxis on contrary to dental extractions. Any instrumentation below the gingival margin needs antibiotic prophylaxis. Practitioners should choose a prophylactic regimen based on the microbial flora at the site of the procedures, the spectrum of activity, cost, and ease of administration of the antibiotic, and a patient history of allergy or sensitivity to antibiotics.
The latest regimens recommended for antibiotic prophylaxis during orthodontic procedures consist of: Amoxicillin 2 g pre-operatively (po) or Clindamycin 600 mg po, or Cephalexin 2 g po, or Cefadroxil 2 g po, or Azithromycin 500 mg po, or Clarithromycin 500 mg po.
If unanticipated bleeding occurs during orthodontic procedures, antibiotics should be prescribed within 2 hours of the start of bleeding.
The recommendations for prevention of bacterial endocarditis in orthodontic procedures will be diagrammatically illustrated during presentation.