Study: Patients with Certain Heart Conditions Should be Given Antibiotics Before Invasive Dental Surgery

Researchers suggest that dentists who do not administer antibiotics to high-risk patients for infective endocarditis could be risking the patient’s life.

Researchers from the University of Sheffield have found a link between infective endocarditis (IE) and having an invasive dental procedure. They suggest giving high-risk patients antibiotic prophylaxis (AP) before the procedure, which challenges current guidelines by the National Institute for Health and Care Excellence (NICE).

“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,” said lead study author Martin Thornhill, professor at the University of Sheffield’s School of Clinical Dentistry, in a press release.

Thornhill added that current UK NICE guidance against AP as a preventative measure could be putting high-risk IE patients at more risk. According to the study, IE kills 30% of people within the first year of development. Caused by bacteria in the mouth, IE can result in a life-threatening heart infection for high-risk patients, which include people with artificial or repaired heart valves, certain congenital heart conditions, or a previous history of IE.

Following this breakthrough, Thornhill and team looked at the association between IE and invasive dental procedures. They published their findings in the Journal of the American College of Cardiology.

The team evaluated 36,773 high-risk patients in the United States over 16 months to compare whether the patients underwent invasive dental treatment with, or without, AP and if they developed IE within 30 days of the procedure. The findings showed that 3774 developed IE within 30 days of their treatment, reflective of another conspicuous finding—high-risk patients were 160 times more at risk of developing IE than the general low-risk population.

High-risk patients were also almost 10 times more likely to develop IE if they got dental extractions without AP cover, and 12.5 times more at risk of IE if they received oral surgery procedures without AP cover compared to high-risk patients with AP cover. Nevertheless, researchers found that almost 70% of patients with high IE risk received no AP before their invasive procedure.

Based off their findings, the team said that the results validate guidelines in the United States and other parts of Europe who continue to recommend antibiotics to patients before their invasive dental procedures.

“It is reassuring for patients, cardiologists and dentists that our data validates the American, European and other guidelines from around the world that recommend that patients at high risk for IE should receive AP before invasive dental procedures,” Thornhill said in the press release. “It is concerning, however, that compliance with this guidance by dentists in the USA was so low. Clearly, more needs to be done to improve compliance with the American Heart Association guidelines.”

Reference

University of Sheffield. Dentists should give antibiotics to high-risk patients to help prevent life-threatening heart infection. EurekAlert! August 18, 2022. Accessed on August 19, 2022. https://www.eurekalert.org/news-releases/962223