Heart Infections on the Rise in Dental Patients After Antibiotic Reductions

In March 2008, the National Institute for Health and Care Excellence issued guidelines recommending that dentists should no longer give antibiotics before invasive treatments to people who are considered at risk of developing a life threatening heart infection. The life threatening heart infection is known as infective endocarditis and 40% of all cases are caused by bacteria in the mouth.

Researchers at the University of Sheffield set out to explore the impact of these guidelines. It was found that an increase in cases of infective endocarditis was observed above what was expected. In March 2013, this increase accounted for an extra 35 cases of infective endocarditis per month. The researchers found that the number of  prescribed antibiotic prophylaxis fell by 89% from 10,900 prescriptions per month, before the 2008 NICE guidelines, to 1,235 a month by March 2008.

The researchers understand that infective endocarditis is a rare infection and want the guideline committees to re-evaluate the benefits and risks of giving antibiotic prophylaxis. It is important to understand that maintaining high standards of oral hygiene can lead to reducing the number of bacteria in the mouth and reducing the number of invasive dental procedures that need to be performed.

The research was funded by a grant from Heart Research UK, Simplyhealth, and the National Institute for Dental and Craniofacial Research. The data was analyzed internationally by experts from the University of Sheffield, Oxford University Hospitals NHS Trust, Taunton and Somerset NHS Trust, the University of Surrey, the Mayo Clinic, and the Carolinas HealthCare System’s Carolinas Medical Center.

Also see a previous blog post of heart infections on dental patients over at http://blog.teethremoval.com/dental-hygiene-prevents-heart-infection/. In this post (2008) it was said

“According to the American Heart Association, those at highest risk for adverse outcomes from IE [infective endocarditis] are 1) patients with a prosthetic cardiac valve or prosthetic material used for cardiac valve repair; 2) previous endocarditis; 3) cardiac transplantation recipients who develop cardiac valve abnormalities; and 4) congenital heart disease for unrepaired cyanotic congenital heart disease, including palliative shunts and conduits; completely repaired congenital heart defect with prosthetic material or device, during the first six months after the procedure; or repaired congenital heart disease with persisting leaks or abnormal flow at the site or adjacent to the site of a prosthetic patch or prosthetic device.”

Source: Mark J Dayer and et. al. Incidence of infective endocarditis in England, 2000–13: a secular trend, interrupted time-series analysis. The Lancet. 2014.

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