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 University of Sheffield.1
These results suggest that current NICE guidelines, advising against routine use of antibiotics before invasive dental procedures for those at high infective endocarditis (IE) risk, should be reconsidered.
The study, led by Professor Martin Thornhill from the University's School of Clinical Dentistry, 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 USA, Europe and elsewhere that recommend that those at high-risk are given antibiotics before invasive dental procedures.
Professor Thornhill said: 'Infective endocarditis is a rare but devastating heart infection in which around 30% of people die within the first year of developing it. We know that 30-45% of IE cases are caused by bacteria that derive from the mouth, but what has been unclear and disputed until now is whether there is a strong link between invasive dental procedures, such as tooth extractions, and IE in patients who are at high risk of developing the infection.
'Results from our study validate for the first time the guidance of the major guideline committees around the world, such as The American Heart Association and the European Society for Cardiology, which recommend that those at high IE risk should receive AP before undergoing invasive dental procedures. In contrast, our data suggests that current UK NICE guidance against the routine use of AP, could be putting high risk patients at unnecessary extra risk of developing IE, and should be reviewed in light of this new evidence.'
Published in the Journal of the American College of Cardiology, the research is the biggest ever study to examine the association between IE - 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 USA where patients at high IE-risk (those with artificial or repaired heart valves, patients with certain congenital heart conditions or a previous history of IE) are recommended to receive antibiotic prophylaxis (AP) before invasive dental procedures, 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.
Thornhill M H, Gibson T B, Yoon F et al. Antibiotic prophylaxis against infective endocarditis before invasive dental procedures. J Am Coll Cardiol 2022; doi: 10.1016/j.jacc.2022.06.030.
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Dentists should give antibiotics to high-risk patients to help prevent life-threatening heart infection. Br Dent J 233, 375 (2022). https://doi.org/10.1038/s41415-022-4999-7