Prosthetic Valve IE Risk — MFDS Part 1 MCQ

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ModerateHuman DiseaseProsthetic Valve IE RiskMFDS Part 1

An adult with rheumatic heart disease has a surgically implanted prosthetic mitral valve and requires a dental extraction. According to current SDCEP implementation advice, which classification and approach to infective endocarditis prophylaxis is correct?

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

Reveal the answer and explanation

Correct answer: C — High risk; offer antibiotic prophylaxis before the extraction

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

A surgically implanted prosthetic heart valve places the patient in SDCEP's high-risk group for infective endocarditis. For a dental extraction, SDCEP advises that antibiotic prophylaxis should be offered, with the potential benefits and harms discussed through shared decision-making. Rheumatic heart disease alone is classified as moderate risk and would not normally require prophylaxis, but the prosthetic mitral valve determines this patient's higher classification; therefore B and D are incorrect. Poor oral hygiene is relevant to prevention and may influence decisions for some gingival or periapical procedures, but prophylaxis is offered for an extraction irrespective of that factor, excluding C. Cardiac liaison may help confirm an uncertain history, but prophylaxis is not conditional on a specific request from the cardiac team, excluding E.

Reference: Scottish Dental Clinical Effectiveness Programme. Antibiotic Prophylaxis Against Infective Endocarditis, 2nd edition, Executive summary: recommendations for high-risk patients and at-risk dental procedures. March 2026. https://www.antibioticprophylaxis.sdcep.org.uk/implementation-advice/executive-summary/executive-summary/