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Is endocarditis prophylaxis for dental procedures necessary?
Kathryn A Taubert1, Walter Wilson2
1American Heart Association , Basel , Switzerland.
Heart Asia
|March 22, 2017
Summary
Antimicrobial prophylaxis before dental procedures for infective endocarditis (IE) prevention is debated. Current guidelines restrict use, and studies show IE incidence has not significantly changed, but more research is needed.
Area of Science:
- Cardiology
- Infectious Diseases
- Dental Medicine
Background:
- Infective endocarditis (IE) is a serious infection, often requiring antibiotic prophylaxis before certain dental procedures for high-risk patients.
- The necessity and efficacy of antibiotic prophylaxis for IE prevention during dental procedures have been questioned since the 1990s.
Purpose of the Study:
- To evaluate the current necessity of antimicrobial prophylaxis before specific dental procedures for patients at increased risk of infective endocarditis (IE).
Main Methods:
- Reviewed American Heart Association (AHA) IE prophylaxis recommendations from 1995 to present.
- Compared current AHA, European Society of Cardiology (ESC), UK NICE, and French guidelines.
- Analyzed recent studies on IE incidence following guideline changes.
Main Results:
- Guidelines evolved to restrict prophylaxis to highest-risk patients.
- Some guidelines, like NICE, removed prophylaxis recommendations for dental procedures.
- Post-guideline studies generally show stable IE incidence, with some reports of slight increases not definitively linked to dental procedures.
Conclusions:
- A definitive answer on the role of antibiotic prophylaxis before dental procedures for IE prevention requires a large, multinational randomized controlled trial.
- Further research should involve diverse populations from both developed and developing countries.
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