How to prevent deaths from infective endocarditis among UK dental patients

Unfortunately for those at high risk, the consequences of developing infective endocarditis (IE) after invasive dental procedures not covered by antibiotic prophylaxis can be devastating for them and their families.

Not all patients at high risk for endocarditis are old; Many are young and have young families. Despite being at high risk, most of these patients lead full and active lives, and the sudden onset of serious illness and urgent hospitalization with IE comes completely unexpected and out of the blue.

Unfortunately, patients quickly become extremely ill, requiring intensive care, intravenous antibiotics and often heart surgery to replace damaged heart valves and treat foci of infection.

About 20% will die during this first hospitalization and a total of about 30% will die in the first year. The consequences of this are devastating for their families, especially those with young children or where the patient is the main breadwinner.

Strokes and distant infections are a common direct complication of infective endocarditis and even patients who survive may suffer catastrophic long-term illness and complications, including heart or kidney failure, or be bedridden from the effects of strokes or infections of the brain or spine . .

Such patients may spend many months in hospital and require constant care and support for the rest of their lives when they are eventually discharged home. The impact of this on families, the healthcare system, the economy and society is enormous.

I think it is clear that there have been a significant number of cases and deaths in IE which could have been prevented if, like all other international guideline committees, the National Institute for Health and Care Excellence had recommended (in 2008) that people with high risk should receive antibiotic prophylaxis.

With regard to dental procedures that are considered invasive – i.e. those that can cause bacteraemia with oral bacteria that can cause IE – there is general acceptance that these include, among others: dental extractions, dental surgical procedures and dental procedures involving manipulation of the gums or the gums are involved. periapical region of the teeth, including scaling and root canal treatment procedures. Such procedures can cause the gums to bleed and result in bacteremia.

Regardless of invasive dental procedures, some cases of IE can also occur in people at increased risk due to daily activities such as brushing teeth, flossing, or chewing food. This is much more likely if oral hygiene is poor or if the teeth are loose due to periodontal disease. Therefore, improving and maintaining good oral hygiene is also important for prevention.

Because of this, there is a tricky conundrum surrounding the procedure of tartar deposition: removing hard deposits of calcified food and bacterial deposits from the teeth. Tartar scaling is important for improving oral hygiene and thus reducing the risk of IE due to poor oral hygiene. But because it is an invasive dental procedure that often disrupts the gums and causes bleeding, the procedure itself carries a risk.

Therefore, even though scaling procedures improve oral hygiene, they should be covered by antibiotic prophylaxis, especially in individuals with poor oral hygiene.