Prosthetic Valve IE Prophylaxis — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementProsthetic Valve IE ProphylaxisORE Part 1

A patient with a surgically implanted prosthetic heart valve, placed 5 years ago, requires extraction of a periodontally involved tooth. According to current SDCEP guidance, which is the most appropriate approach to infective endocarditis prophylaxis?

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Correct answer: D — Offer antibiotic prophylaxis before extraction, with shared decision-making

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

A is correct. Current SDCEP advice classifies surgically implanted prosthetic valves as high risk for infective endocarditis and advises that high-risk patients should be offered antibiotic prophylaxis before dental extractions. The decision must include discussion with the patient of potential benefits and harms; routine cardiology approval is not required when the cardiac diagnosis is clear. B is wrong because the 6-month limitation applies to some repaired congenital cardiac defects or specified devices, not prosthetic valves. C is wrong because the indication relates to the extraction, not the anaesthetic technique. D is unnecessarily restrictive. E confuses prophylaxis with treatment of an established infection. NICE continues to state that prophylaxis is not routine generally, while directing dental teams managing high-risk patients to the UK-endorsed SDCEP advice.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Antibiotic Prophylaxis Against Infective Endocarditis: Implementation Advice, 2nd edition, Executive summary, March 2026. https://www.antibioticprophylaxis.sdcep.org.uk/implementation-advice/executive-summary/executive-summary/