Dentists should give antibiotics to high-risk patients to help prevent life-threatening heart infection, study suggests

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use of antibiotics in dentistry
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People who are at high risk of developing a life-threatening heart infection should be given antibiotics before undergoing invasive dental procedures according to new research from the UK.

The study by a team at the University of Sheffield, England, suggests that current UK guidelines against the use of antibiotics, issued by the National Institute for Health and Care Excellence (NICE), could be putting high-risk patients at unnecessary extra risk when undergoing invasive dental procedures.

At the same time, the results validate guidance in the US, Europe and elsewhere that recommend that those at high-risk be given antibiotics before invasive dental procedures.

Published in the Journal of the American College of Cardiology, the research is the biggest ever study to examine the association between infective endocarditis—a life-threatening infection of the heart often caused by bacteria that derive from the mouth—and invasive dental procedures.

The study was performed in the US where patients at high IE-risk are recommended to receive antibiotics before invasive dental procedures—called antibiotic prophylaxis (AP)—to reduce their risk of developing IE.

The research is the first to demonstrate that AP reduces the risk of IE following invasive dental treatment for those at high-risk of developing the infection.

Since the 1950s, guideline committees around the world have recommended that people at increased risk of IE should be given AP before undergoing invasive dental procedures. However, there has never been any robust research directly linking dental procedures with the development of IE or any study to demonstrate that AP is effective in reducing the risk of developing IE.

Due to this lack of evidence, concerns about the unnecessary use of antibiotics and the risk that AP could promote the development of antibiotic resistant bacteria, guideline committees have since reduced the number of people that AP is recommended for—recommending that only those at high risk for IE should receive AP before invasive dental procedures. In the UK, however, NICE went even further, stating: “Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.”

The study from Sheffield analysed the medical history of nearly eight million people in the US over a 16-month period, including 36,773 individuals at high-risk of IE. The researchers looked at whether the patients had invasive dental treatment, if they then went on to develop IE within 30 days and whether they had been given AP before the procedure.

The researchers found that 3774 of those studied developed IE within 30 days of dental treatment. They also found that the risk of developing IE was 160 times greater in those at high IE-risk than in the general low-risk population.

The association between invasive dental procedures an IE was particularly strong for dental extractions and oral surgical procedures. 

The study found however that only 32.6 per cent of high IE-risk patients received AP before invasive dental procedures. This allowed the researchers to study the effectiveness of AP. They found that the risk of developing IE was nearly 10 times greater when dental extractions were performed in high-risk patients without AP cover than when performed with AP cover. Similarly, the risk of IE was 12.5 times greater when oral surgery procedures were performed in high-risk patients without AP cover than when performed with AP cover.

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