treatment may play in causing adverse outcomes in these patients. Recommendations The Scottish Dental Clinical Effectiveness Programme (SDCEP) had published recommendations in this scope (August 2018) for the dental team on how best to adhere to the guidelines by NICE. These recommendations have been recognised and acknowledged by NICE in July 2018. The recommendations aim to clarify circumstances and management when patients are not within the scope of NICE's guideline on antibiotic prophylaxis. Considerations should be undertaken by healthcare professional as well to exercise their clinical judgement and patient's consent in decision-making. Infective Endocarditis (IE) is the infection of heart valves. Previous beliefs were held that IE can be induced from dental procedures due to the invasive nature of treatment, therefore antibiotics were widely prescribed before dental treatment to prevent this. This belief has changed with evidence to show that the risk of IE occurrence from everyday routine such as toothbrushing and eating is the same as that of undergoing invasive dental procedure. Increasing concerns regarding rise in antibiotic resistance have also pushed for change in advice on antibiotic prophylaxis, where the British National Formulary (BNF) has now opposed the use of antibiotic prophylaxis in dentistry. Unsatisfactory evidence to conclude whether antibiotic prophylaxis is useful in patients at risk of IE before dental treatment. It is now established that ‘Antibiotic prophylaxis against IE is not recommended routinely for people undergoing dental procedures’ according to NICE 2016, recommendation 1.1.3. Group of patients with higher risks Only a selected body of patients are categorized with a more significant risk of IE who might require antibiotic prophylaxis. These patients undergo non-routine management. Prosthetic valves which include a transcatheter value, or those with prosthetic material used for cardiac valve repair Previous incidence of IE Congenital heart disease (CHD) - any type of cyanotic CHD, or any type of CHD repaired with a prosthetic material (via surgical or percutaneous techniques) Up to 6 months after procedure or lifelong if residual shunt or valvular regurgitation remains [Table adapted from SDCEP AB Prophylaxis against IE] Management of patients High risk Check patient's cardiac condition and determine whether they belong in the selected body of patients who are at a more significant risk of IE. If they do, the dentist should consult with the patient's cardiologist regarding antibiotic cover before dental treatment. Antibiotic cover is only considered when undergoing invasive dental procedures. If no antibiotic cover is needed,