UK dentists should give antibiotics to patients at risk of heart infection: study |  dentists

UK dentists should give antibiotics to patients at risk of heart infection: study | dentists

Dentists in the UK should be encouraged to give antibiotics to patients at high risk of life-threatening heart infection before invasive procedures, according to a study.

Research suggests that bacteria from the mouth that enter the bloodstream during dental treatment could account for 30% to 40% of cases of infective endocarditis. The rare but life-threatening condition occurs when the inner lining of the heart’s chambers and valves becomes infected.

Antibiotics could limit the number of cases and reduce the risk of heart failure, stroke and premature death in high-risk patients, the study says.

Current guidelines from the National Institute for Health and Care Excellence (Nice) advise against the routine use of antibiotics before invasive dental procedures for people at risk of infective endocarditis.

“Ours is the largest study to show a significant association between invasive dental procedures and infective endocarditis, particularly for extraction and surgical procedures,” said Professor Martin Thornhill of the University of Sheffield, who led the study.

Nice should review its guidelines that advise against antibiotic prophylaxis, the researchers said.

Guideline committees in other countries, including the American Heart Association and the European Society of Cardiology, recommend antibiotics for high-risk patients.

“The data strongly validates the guidance of nearly every committee in the world, particularly the American Heart Association, that recommends antibiotic prophylaxis for high-risk patients,” Thornhill said.

The team analyzed the medical, dental, and prescription records of nearly 8 million people in the US. Nearly 37,000 participants were at high risk for endocarditis.

The risk of infective endocarditis was 10 times lower in high-risk patients who took antibiotics before dental extractions compared with those who did not, and 12.5 times lower before surgical procedures.

“We were able to compare high-risk people who received antibiotic prophylaxis and those who did not, and we clearly showed a lower risk of infection after invasive antibiotic procedures,” Thornhill said.

Nice guidance needs to be updated and clarified, Thornhill said: “The guidance is just not clear. The wording is very ambiguous and leaves open the question of whether certain patients should receive antibiotic prophylaxis.

“The current study provides the evidence needed to discuss risks with patients and for dentists to recommend antibiotics when necessary,” Thornhill added.

A Nice spokesperson said: “Nice takes a proactive approach to updating its guidelines, including reacting to and taking into consideration any new evidence and its potential to impact current recommendations.”

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