Table 3.138.

Key considerations for dental management in rheumatic fever (see text)

	Management modifications*	Comments/possible complications
Risk assessment	3	During acute attack – only emergency dental care
Appropriate dental care	2	Postpone elective dental care 6 months; referral to a cardiologist; antibiotic prophylaxis against endocarditis
Pain and anxiety control
– Local anaesthesia	1	Use epinephrine with caution
– Conscious sedation	4/5
– General anaesthesia	5
Patient access and positioning
– Access to dental office	0
– Timing of treatment	0
– Patient positioning	0
Treatment modification
– Oral surgery	0
– Implantology	0
– Conservative/Endodontics	0
– Fixed prosthetics	0
– Removable prosthetics	0
– Non-surgical periodontology	0
– Surgical periodontology	0
Hazardous and contraindicated drugs	1	Many are given anticoagulants; possibly antibiotic resistance

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.