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Active IE Source Extraction — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementActive IE Source ExtractionORE Part 1

A patient is an inpatient with active infective endocarditis confirmed by the cardiology team. The endocarditis team considers an acutely infected tooth to be the likely ongoing oral source and requests urgent removal. What is the most appropriate dental management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Extract the tooth within the agreed endocarditis treatment plan after liaison with the responsible team.

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · E = shown as D · B = shown as E

A is correct. Where an acutely infected tooth is judged by the endocarditis team to be an ongoing source, urgent extraction is a source-control measure and should be undertaken as part of the coordinated inpatient IE plan. The dentist must liaise with the treating cardiology/microbiology team regarding timing, clinical stability, investigations and the therapeutic antimicrobial regimen already prescribed; this is not routine outpatient antibiotic prophylaxis. B and C incorrectly impose blanket delay or prohibition, leaving a potential focus untreated. D is unnecessarily absolute: the required clinical setting depends on the patient’s stability and local specialist arrangements, not an automatic requirement for cardiac theatre. E is inappropriate because prolonged oral antibiotics without removal of an indicated infected focus is not adequate source control.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Management of patients at high and moderate risk of infective endocarditis, 2026. https://www.antibioticprophylaxis.sdcep.org.uk/media/ih0hgqbx/management-of-patients-at-high-and-moderate-risk-of-infective-endocarditis-flowchart.pdf