Infective Endocarditis is not nice!

NICE (National Institute for Health and Clinical Excellence) has recently produced a new set of guidelines for antibiotic cover (prophylaxis) when going to the dentist. This has understandably caused some concern with GUCHs and I have been discussing the matter of infective endocarditis (IE) risk with the medical trustees.

NICE based their guidelines on various findings and conclusions:

• inconsistent evidence between procedures and cases of IE and that the number of cases of IE are likely to be extremely small;
• exposure to bacteria caused by every day activities such as brushing teeth and chewing greatly exceeds that caused by most dental procedures;
• antibiotics do not necessarily abolish but only reduce bacteria after certain procedures;
• antibiotics are only partially effective in preventing IE as there have been cases of IE even when antibiotics have been given;
• antibiotics may cause harm as penicillin based antibiotics are likely to cause more deaths from allergic reaction than save lives from endocarditis;
• widespread use of antibiotics is leading to resistant strains of bacteria.

The medical trustees, whilst not disagreeing with the points made by NICE, are not so sure about the conclusion. They point out that there have been no trials to show what outcomes would be without antibiotic cover and therefore no proof that the incidence of IE is not going to be greater without it.

Now that NICE has pronounced, dentists and perhaps even GPs are very unlikely to prescribe antibiotics for GUCHs for dental procedures whatever anyone thinks. The new guideline however emphasises the freedom for clinical judgement to be used in individual cases and the importance of explaining the risks and possible benefits of either accepting the new guidelines or continuing with antibiotic cover.

From a personal point of view, I have had antibiotic cover when visiting the dentist for years. The chance of me having a reaction to them is therefore very minimal. I have also had IE, not from dental work but I know it is not something I want again as it is very nasty indeed and can kill. I will be asking my GP and if necessary my Consultant to write a letter confirming to my dentist that I should continue with antibiotic cover. My advice to anyone with concerns is to speak to either their GP or Consultant (or both) to get their advice.

All that said the most important part of all is to bear in mind the point about day to day exposure to bacteria and the importance of good dental hygiene. Cleaning your teeth at least once a day and going to the dentist every six months is easily the most important aspect of avoiding IE.