In a study from the University of Sheffield, scientists found people who are at high risk of developing a life-threatening heart infection should be given antibiotics before undergoing invasive dental procedures.
The study suggests that current UK guidelines against the use of antibiotics could be putting high-risk patients at unnecessary extra risk when undergoing invasive dental procedures.
The research is the biggest ever study to examine the association between infective endocarditis—a life-threatening infection of the heart often caused by bacteria that derive from the mouth—and invasive dental procedures.
What has been unclear and disputed until now is 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.
The study was performed in the U.S. where patients at high IE-risk (those with artificial or repaired heart valves, patients with certain congenital heart conditions, or a previous history of IE) are recommended to receive antibiotics before invasive dental procedures—called antibiotic prophylaxis (AP)—to reduce their risk of developing IE.
The research is the first to show that AP reduces the risk of IE following invasive dental treatment for those at high risk of developing the infection.
The team analyzed the medical history of nearly eight million people in the U.S. over a 16-month period, including 36,773 people 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.
They 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 association between invasive dental procedures and IE was particularly strong for dental extractions and oral surgical procedures.
For patients at high IE risk, the risk of developing IE was one in every 250 extractions and one in every 100 oral surgery procedures without AP cover. The risk in the low-risk population was extremely small.
The study found that only 32.6 percent of high IE-risk patients received AP before invasive dental procedures. This allowed the researchers to study the effectiveness of AP.
They 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 data validates the American, European and other guidelines from around the world that recommend that patients at high risk for IE should receive AP before invasive dental procedures.
For more information about heart health, please see recent studies about a big cause of heart failure, and scientists find a new way to repair the human heart.
The study was conducted by Professor Martin Thornhill et al and published in the Journal of the American College of Cardiology.
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