British dentists must 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 a life-threatening heart infection before invasive procedures, a study finds.

Research suggests that oral bacteria that enter the bloodstream during dental treatments may explain 30% to 40% of infective endocarditis cases. The rare but life-threatening condition occurs when the inner lining of the heart’s chambers and valves become infected.

Antibiotics could limit the number of cases and reduce the risk of heart failure, stroke and early death in at-risk patients, the study said.

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

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

Nice should review its guidelines on 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 guidelines of nearly all committees around the world, especially the American Heart Association, which recommend 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 smaller in at-risk patients who took antibiotics before dental extractions compared to those who didn’t, and 12.5 times smaller before surgical procedures.

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

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

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

A Nice spokesperson said: “Nice is taking a proactive approach to update its guidelines, including responding to and taking into account new evidence and the potential to influence current recommendations.”

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