Correspondence from the world of cardiology
There has been much debate regarding the prophylactic prescribing of antibiotics in patients deemed at risk of developing infective endocarditis (IE) as a result of certain dental procedures.1 The National Institute for Health and Care Excellence (NICE), the British Society for Antimicrobial Chemotherapy (BSAC) and the American Heart Association (AHA) have produced differing guidelines for dental practitioners, who may decide to accept one particular code entirely, or a modified version based on discussion with local cardiology departments.
This culture of debate amongst cardiologists, dentists and patients regarding best interest, success rates, allergy and development of antibiotic resistance, can only be of relevance when all preventative parameters are first exhausted and the patient’s individual risk is brought to the lowest level reasonably possible prior to scheduled surgery.2
Removing potential causes of infection as well as reducing the risk of bacteraemia-associated complications, when preformed preoperatively, could reduce the future likelihood of developing the disease.3 A pragmatic approach would be to complete a hospital-based, dentist led, oral health risk assessment pre-operatively, for patients scheduled to receive cardiac surgery associated with those conditions which all guidelines consider to pose a risk, with intervention taken where necessary.
Perhaps at hospital level we should place a greater emphasis on oral screening during pre-operative assessment clinics, to both reduce the future risk of IE and add further to the discussion of prophylactic antibiotic prescribing.
Conflict of interest
Mervyn Huston, Dental Surgeon
Musgrove Park Hospital Taunton, Taunton and Somerset NHS Foundation Trust, Musgrove Park, Parkfield Drive, Taunton, Somerset TA1 5DA
1. Glenny AM, Oliver R, Roberts GJ, Hooper L, Worthington HV. Antibiotics for the prophylaxis of bacterial endocarditis in dentistry. Cochrane Database Syst Rev 2013. http://dx.doi.org/10.1002/14651858.CD003813.pub4
2. Rahman N, Rogers S, Ryan D, Healy C, Flint S. Infective endocarditis prophylaxis and the current AHA, BSAC, NICE and Australian guidelines. J Ir Dent Assoc 2008;54:264–70.
3. Yasny JS, Silvay G. The value of optimizing dentition before cardiac surgery. J Cardiothorac Vasc Anesth 2007;21:587–91.