OK to limit pre-dental procedure antibiotics to high risk heart patients

June 11, 2012

The incidence of infective endocarditis among dental patients in Olmsted County, Minn. did not increase after new guidelines called for giving preventive antibiotics before dental procedures only to those at greatest risk of complications, according to independent research published in Circulation, an American Heart Association journal.

Infective endocarditis is a of the lining, heart valve or blood vessel. Although rare, it can occur when bacteria enter the bloodstream through breaks in the gums during invasive dental procedures or oral surgery. It can cause death if untreated. A common group of bacteria that cause this infection is viridans group streptococci (VGS).

Patients with a heart weakened by certain and acquired conditions, including those with prosthetic , can be more susceptible to the infection. People with normal heart valves develop the infection less often.

In 2007, the changed its guidelines, recommending patients take antibiotics before invasive dental procedures only if they are at risk of complications from . This includes patients with artificial heart valves, transplanted hearts with abnormal heart valve function, previous infective endocarditis and people born with specific .

Before 2007, antibiotics were given to many more people, including those with many types of or acquired cardiac condition. Antibiotics also were given for a wider range of procedures, including operations involving the mouth, throat, gastrointestinal, genital or urinary tract.

"We were giving preventive antibiotics like we were treating an entire iceberg, when we only needed to treat the very tip of that iceberg," said Daniel C. DeSimone, M.D., study lead author and an internal medicine resident at the Mayo Clinic in Rochester, Minn. "Millions of people once getting antibiotics now are not."

In the first U.S. study examining VGS-related infective endocarditis rates after the guidelines changed, investigators found a slight decline in the number of patients diagnosed.

To compare infective endocarditis rates, researchers analyzed local hospital discharge records in the Rochester Epidemiology Project and national rates using the Nationwide Inpatient Sample. Olmstead County was used because of its unique medical records-linkage system that encompasses all residents of the county.

From Jan. 1, 1999 to Dec. 31, 2010, 22 patients in Olmsted County, Minn., were diagnosed with the heart infection. These patients represent two to three of every 100,000 people in the United States before updated guidelines, and one of every 100,000 after the updated guidelines.

The percentage of Olmsted county dentists following the new association guidelines represented the percentage of dentists using them nationally, researchers said.

The national annual infective endocarditis diagnosis rates showed no increase, ranging from:

  • 15,300-17,400 in 1999-2006 (before the updated guideline)
  • 14,700-15,500 in 2007-09 (after the updated guideline)
"These findings are reassuring, but additional studies are needed to further support our findings," DeSimone said.

"There's still a concern among many healthcare providers over whether we are leaving certain people at risk of getting a potentially lethal infection just from a dental cleaning or tooth extraction," he said. "This study should reduce some fears. It will allow dentists to become more comfortable when they tell a patient, 'You've been getting this antibiotic for years. Now, it's not recommended anymore, and here is data showing you why.'"

Among other limitation, the lack of diversity in Olmstead means these results may not hold true for non-Caucasian populations.

Explore further: Dental plaque bacteria may trigger blood clots

More information: Abstract
Full Text

Related Stories

Dental plaque bacteria may trigger blood clots

March 26, 2012
Oral bacteria that escape into the bloodstream are able to cause blood clots and trigger life-threatening endocarditis. Further research could lead to new drugs to tackle infective heart disease, say scientists presenting ...

Surgery improves endocarditis-induced heart failure survival rates

November 22, 2011
Surgery significantly improves short- and long-term outcomes in patients with heart failure caused by a bacterial infection known as endocarditis, according to Duke University Medical Center researchers.

Heart infection involving ICD associated with high rate of complications, risk of death

April 24, 2012
Patients with infective endocarditis involving implanted cardiac devices experience a high rate of complications such as valve infections, heart failure, and persistent bacteremia, and high in-hospital and 1-year mortality ...

Recommended for you

Could this protein protect people against coronary artery disease?

November 17, 2017
The buildup of plaque in the heart's arteries is an unfortunate part of aging. But by studying the genetic makeup of people who maintain clear arteries into old age, researchers led by UNC's Jonathan Schisler, PhD, have identified ...

Raising 'good' cholesterol fails to protect against heart disease

November 16, 2017
Raising so-called 'good' cholesterol by blocking a key protein involved in its metabolism does not protect against heart disease or stroke, according to a large genetic study of 150,000 Chinese adults published in the journal ...

New model estimates odds of events that trigger sudden cardiac death

November 16, 2017
A new computational model of heart tissue allows researchers to estimate the probability of rare heartbeat irregularities that can cause sudden cardiac death. The model, developed by Mark Walker and colleagues from Johns ...

Popular e-cigarette liquid flavorings may change, damage heart muscle cells

November 16, 2017
Chemicals used to make some popular e-cigarette liquid flavorings—including cinnamon, clove, citrus and floral—may cause changes or damage to heart muscle cells, new research indicates.

Possible use for botulinum toxin to treat atrial fibrillation

November 16, 2017
From temporarily softening wrinkles to easing migraines, botulinum toxin has become a versatile medical remedy because of its ability to block nerve signals that can become bothersome or risky.

Proteome of the human heart mapped for the first time

November 15, 2017
A healthy heart beats about two billion times during a lifetime, thanks to the interplay of more than 10,000 proteins. Researchers from the Max Planck Institute of Biochemistry (MPIB) and the German Heart Centre at the Technical ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.