The study, led by Professor Martin Thornhill from the University of Sheffield’s School of Clinical Dentistry, suggests that current guidelines in the UK issued by the National Institute for Health and Care Excellence against the use of antibiotics could be putting high-risk patients at unnecessary extra risk when undergoing invasive dental procedures, the university said in a press release on Thursday.
Thornhill said 30-45 per cent of infective endocarditis (IE) cases are caused by bacteria that derive from the mouth, but what has been unclear and disputed until now was 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 the 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 antibiotic prophylaxis (AP) before undergoing invasive dental procedures, he said.
The current UK NICE guidance against the routine use of antibiotic prophylaxis should be reviewed in light of this new evidence, Thornhill said.
The study analysed the medical history of nearly eight million people in the USA 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.
Researchers found that 3,774 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 study found that only 32.6 per cent of high IE-risk patients received AP before invasive dental procedures. It 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.
The study titled ‘Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures’ is published in the Journal of the American College of Cardiology.