Dental Tribune Europe

Rise in endocarditis despite antibiotics guidelines for dentists

By Dental Tribune International
November 26, 2014

SHEFFIELD, UK: Scientists at the University of Sheffield have identified a significant rise in the number of people diagnosed with a serious heart infection alongside a large fall in the prescription of antibiotic prophylaxis to dental patients owing to respective guidelines introduced several years ago. The researchers suggest that their results will provide the information the guideline committees need to re-evaluate the benefits of administering antibiotics as a preventative measure.

The pioneering study is the largest and most comprehensive to be conducted with regard to the National Institute for Health and Care Excellence (NICE) guidelines, which recommend that dentists no longer give antibiotics before invasive treatments to patients considered at risk of the life-threatening heart infection infective endocarditis, which in 40 per cent of cases is caused by bacteria from the mouth.

The team of international researchers, led by Prof. Martin Thornhill at the University of Sheffield’s School of Clinical Dentistry, discovered that since the NICE guidelines were introduced in March 2008, there has been an increase in cases of infective endocarditis above the expected trend. By March 2013, this accounted for an extra 35 cases per month.

They also identified that the prescription of prophylactic antibiotics fell by 89 per cent from 10,900 prescriptions a month before the 2008 guidelines to 1,235 prescriptions a month by March 2013.

Thornhill, Professor of Oral Medicine, said: “Infective Endocarditis is a rare but serious infection of the heart lining. We hope that our data will provide the information that guideline committees need to re-evaluate the benefits, or not, of giving antibiotic prophylaxis.”

Thornhill stressed that health care professionals and patients should wait for the guideline committees to evaluate the evidence and give their advice before changing their current practice.

He added: “In the meantime, healthcare professionals and patients should focus on maintaining high standards of oral hygiene. This will reduce the number of bacteria in the mouth which have the potential to cause Infective Endocarditis and reduce the need for invasive dental procedures to be performed.”

Barbara Harpham, National Director of Heart Research UK, said: “The findings play an important part in the ongoing exploration of the link between dental and heart health. Projects such as this one are vital to the ongoing collation of evidence to support our understanding of how oral health can impact upon the heart and other conditions within the body. We are committed to furthering medical research in the UK and welcome these new findings.”

The data was analysed by an international group of experts from the University of Sheffield, Oxford University Hospitals NHS Trust, Taunton and Somerset NHS Foundation Trust, and the University of Surrey in the UK, as well as from Mayo Clinic and the Carolinas HealthCare System’s Carolinas Medical Center in the US. The study was published in The Lancet journal online on 18 November under the title “Incidence of infective endocarditis in England, 2000–13: A secular trend, interrupted time-series analysis” and presented last week to more than 19,000 international attendees at the American Heart Association annual meeting in Chicago.

The research was funded by a grant from national heart charity Heart Research UK, health care provider Simplyhealth and the National Institute of Dental and Craniofacial Research.

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