Antibiotic prophylaxis for dental procedures: is it necessary?

Area of Science:

• Dental Medicine
• Infectious Disease Prevention
• Public Health Policy

Background:

• Conflicting international guidelines for infective endocarditis prevention exist (British Society for Antimicrobial Chemotherapy 2006, American Heart Association 2007, NICE 2008).
• Suitability and adherence to these guidelines in developing countries like South Africa are unknown.
• General dental practitioners' practices regarding antibiotic prophylaxis require investigation.

Purpose of the Study:

• To assess South African dental practitioners' awareness of recent American Heart Association (AHA) and National Institute for Health and Clinical Excellence (NICE) guidelines.
• To evaluate current practices in antibiotic prophylaxis among these practitioners.

Main Methods:

• An internet-based survey was distributed via e-mail to dentists registered with the South African Dental Association (SADA).

Main Results:

• A low response rate was observed, necessitating data pooling.
• While 88% were aware of AHA guidelines, only 55% knew of NICE guidelines.
• Few practitioners adhered to recommendations or correctly prescribed prophylaxis for penicillin-allergic patients, suggesting potential inappropriateness of current guidelines given high rheumatic fever rates.

Conclusions:

• Despite a small sample size, concerning trends in antibiotic prophylaxis practices were identified.
• There is a clear need for the development of local guidelines for infective endocarditis prevention in South Africa.
• Effective dissemination of new, appropriate guidelines to dental practitioners is urgently required.