Top Things to Know: Prevention of Viridans Group Streptococcal Infective Endocarditis

Published: April 15, 2021

  1. This update addresses the impact of the major changes made in the 2007 IE Guideline: What was the acceptance of and compliance with recommendations for AP for those who undergo a dental procedure? Was there an increased incidence of viridians group streptococci (VGS) infective endocarditis (IE)? Were the recommendations valid and should they be revised?
  2. Antibiotic prophylaxis for a dental procedure that involves manipulation of gingival tissues, periapical region of teeth, or perforation of the oral mucosa is suggested only for those patients with the highest risk of adverse outcome from VGS IE such as heart failure, aortic root abscess, need for cardiac valve replacement, and congenital heart disease where morbidity is high from IE.
  3. VGS IE is much more likely caused by transient VGS bacteremia from an oral source resulting from daily routine activities than from a dental procedure.
  4. Maintenance of good oral health and regular access to dental care are more important to prevent VGS IE than antibiotic prophylaxis (AP) for a dental procedure.
  5. Often, due to lack of insurance and/or affordability, access to regular dental care is limited for patients. This is especially important in those patients at risk of the highest adverse outcome from VGS IE.
  6. It is important to connect patients with a social worker or other services to facilitate wider access to dental care and assistance with insurance for dental services coverage.
  7. An exceeding small number of cases of VGS IE could be prevented by AP for a dental procedure, even if prophylaxis is 100% effective.
  8. AP for a dental procedure is not suggested based solely on an increased lifetime risk of acquisition of VGS IE
  9. There is no convincing evidence of an increased frequency of or morbidity or mortality from VGS IE in patients with low, moderate, or high risk of adverse outcome since publication of the 2007 document.
  10. There may be instances when a health care provider and a patient disagree with the suggestions in the 2020 statement. In these cases, the health care provider should adequately inform patients of the risks and benefits of AP for a dental procedure so that an informed decision may be made.


Wilson WR, Gewitz M, Lockhart PB, Bolger AF, DeSimone DC, Kazi DS, Couper DJ, Beaton A, Kilmartin C, Miro JM, Sable C, Jackson MA, Baddour LM; on behalf of the American Heart Association Young Hearts Rheumatic Fever, Endocarditis and Kawasaki Disease Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular and Stroke Nursing; and the Council on Quality of Care and Outcomes Research. Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association [published online ahead of print April 15, 2021]. Circulation. doi: 10.1161/CIR.0000000000000969.