An infective endocarditis audit illustrates why dental guidelines in general need to be kept clear, simple and...

To test the effect complex, multiple dental guidelines have on establishing compliance with ideal clinical practice.

A questionnaire was used to determine the level of knowledge of the British Cardiac Society and Royal College of Physicians 2004 infective endocarditis prophylaxis guidelines which were contemporary at the time the study was initiated, as well as to identify the existence of any written departmental policies on the safe management of patients at risk of developing this disease.

Hospital Orthodontic Departments in the East of England.

Fourteen consultant and nine training grade group hospital orthodontists in the East of England initially answered the questionnaire in November 2005. The results of the survey were then discussed at a subsequent regional audit meeting after which standards were agreed. The original questionnaire was then reissued in June 2006 to 13 and eight of the original consultants and training grade group orthodontists respectively. This was coincidently three months after the publication of further new infective endocarditis prophylaxis guidance from the working party of the British Society for Antimicrobial Chemotherapy.

The initial results indicated a number of significant deficiencies in the knowledge of which dental procedures either did or did not need antibiotic prophylaxis that the subsequent audit then improved to a variable extent. Nevertheless, the general finding was one of persistent confusion regarding the multiple conflicting contemporaneous guidelines. This lends further support to the concept of converging guidelines which remain disunified, complex and non-evidence based.

The results of this audit confirm that compliance with preferred clinical practice is noticeably compromised when complex conflicting guidelines from either different national or international authoritative bodies exist for the same condition. With particular regard to the dental guidance for infective endocarditis prophylaxis, this has now been largely circumvented in the United Kingdom by the publication of a single, unambiguous guideline from the National Institute of Health and Clinical Excellence (NICE) in March 2008.