Management of emergency patients

Identifying whether a patient at increased risk of infective endocarditis has a high risk or moderate risk cardiac condition when they register with your practice, or when they are first diagnosed, will ensure that the relevant information is available if they require emergency dental treatment. However, it is recognised that some patients at increased risk of infective endocarditis may seek emergency dental care from a dental practice or out-of-hours dental clinic where an assessment of their cardiac condition may not have taken place and where it may not be possible to seek advice from the patient’s cardiac team(s).

Ensure that any episodes of dental infection in patients at increased risk of infective endocarditis are investigated and treated promptly to reduce the risk of endocarditis developing.

Where treatment of the dental emergency is beyond your competency, seek advice from an appropriate expert based on your clinical judgement and the individual circumstances.

If a patient with a cardiac condition who is unknown to the practice presents with a dental emergency, and the patient is not able to confirm whether their cardiac condition puts them at increased risk of infective endocarditis, consider seeking prompt advice on the appropriateness of antibiotic prophylaxis from their supervising cardiac team, where possible.

Many patients will know what operations they have had or will have clinic letters which can provide relevant information.
Where it has not been possible to obtain prompt advice from the patient's cardiac team, make a shared decision on antibiotic prophylaxis, based on a discussion with the patient regarding their values and preferences.

Note that antibiotic prophylaxis is not recommended following trauma to the lips or oral mucosa (see 'At-risk' dental procedures).