Oral hygiene and infective endocarditis: a case control study

Lockhart, Peter B.; Chu, Vivian H.; Zhao, Jun; Gohs, Frank; Thornhill, M; Pihlstrom, Bruce Lee; Mougeot, Farah Bahrani; Rose, Geoffrey; Sun, Yee-Ping; Napeñas, Joel J.; Munz, Stephanie M.; Farrehi, Peter; Sollecito, Thomas P.; Sankar, Vidya; O’Gara, Patrick T.

doi:10.1016/j.oooo.2023.02.020

Cited by 5 publications

(3 citation statements)

References 35 publications

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“… 35 Consistent with this, a recent large study showed that poor oral hygiene was a significant independent risk factor for the development of IE caused by oral bacteria. 36 Hence, despite being an IDP, regular scaling may reduce the risk of IE by improving oral hygiene over the long term. In contrast, dental extractions and oral surgical procedures are more likely to be indicated in those who neglect their oral hygiene.…”

Section: New Evidencementioning

confidence: 99%

Endocarditis prevention: time for a review of NICE guidance

Thornhill,

Prendergast,

Dayer

et al. 2024

The Lancet Regional Health - Europe

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Section: New Evidencementioning

confidence: 99%

Endocarditis prevention: time for a review of NICE guidance

Thornhill,

Prendergast,

Dayer

et al. 2024

The Lancet Regional Health - Europe

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“…44 Maintenance of good oral hygiene is, therefore, paramount in reducing the risk of IE and a recent clinical trial demonstrated that moderate-risk patients with markers of poor oral hygiene were significantly more likely to develop IE. 45 The authors concluded that 'those at risk for IE can reduce potential sources of IE-related bacteraemia by maintaining optimal oral health through regular professional dental care and oral hygiene procedures' . Of note, the advantages of good oral hygiene are important not just for those at high risk (where the benefits of AP appear to be focused) but also for those at moderate risk (who may not benefit from AP).…”

Section: Ap Efficacymentioning

confidence: 99%

New evidence calls into question NICE's endocarditis prevention guidance

Thornhill,

Prendergast,

Dayer

et al. 2024

Br Dent J

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In 2008, National Institute for Health and Care Excellence (NICE) guidelines recommended against the use of antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to prevent infective endocarditis (IE). They did so because of lack of AP efficacy evidence and adverse reaction concerns. Consequently, NICE concluded AP was not cost-effective and should not be recommended. In 2015, NICE reviewed its guidance and continued to recommend against AP. However, it subsequently changed its wording to ‘antibiotic prophylaxis against infective endocarditis is not routinely recommended'. The lack of explanation of what constituted routinely (and not routinely), or how to manage non-routine patients, caused enormous confusion and NICE remained out of step with all major international guideline committees who continued to recommend AP for those at high risk.Since the 2015 guideline review, new data have confirmed an association between IDPs and subsequent IE and demonstrated AP efficacy in reducing IE risk following IDPs in high-risk patients. New evidence also shows that in high-risk patients, the IE risk following IDPs substantially exceeds any adverse reaction risk, and that AP is therefore highly cost-effective. Given the new evidence, a NICE guideline review would seem appropriate so that UK high-risk patients can receive the same protection afforded high-risk patients in the rest of the world.

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“…Recent data strongly suggest that poor oral hygiene increases the risk of IE in those at moderate and high risk 17,18 and these patients should be aware of the importance of achieving and maintaining good oral hygiene through regular professional and personal dental care. 18 Recommended measures include oral hygiene instruction, advice on adjunctive oral hygiene procedures and regular scaling and polishing. However, it should be remembered that scaling is an IDP, requiring discussion of the risks and benefits of the procedure and use of AP.…”

Section: Advice For Patients At Increased (High/moderate) Ie Riskmentioning

confidence: 99%

Prevention of infective endocarditis in at-risk patients: how should dentists proceed in 2024?

Thornhill,

Prendergast,

Dayer

et al. 2024

Br Dent J

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National Institute for Health and Care Excellence (NICE) guidelines are ambiguous over the need for patients at increased risk of infective endocarditis (IE) to receive antibiotic prophylaxis (AP) prior to invasive dental procedures (IDPs), and this has caused confusion for patients and dentists alike. Moreover, the current law on consent requires clinicians to ensure that patients are made aware of any material risk they might be exposed to by any proposed dental treatment and what can be done to ameliorate this risk, so that the patient can decide for themselves how they wish to proceed. The aim of this article is to provide dentists with the latest information on the IE-risk posed by IDPs to different patient populations (the general population and those defined as being at moderate or high risk of IE), and data on the effectiveness of AP in reducing the IE risk in these populations. This provides the information dentists need to facilitate the informed consent discussions they are legally required to have with patients at increased risk of IE about the risks posed by IDPs and how this can be minimised. The article also provides practical information and advice for dentists on how to manage patients at increased IE risk who present for dental treatment.

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Oral hygiene and infective endocarditis: a case control study

Cited by 5 publications

References 35 publications

Endocarditis prevention: time for a review of NICE guidance

Endocarditis prevention: time for a review of NICE guidance

New evidence calls into question NICE's endocarditis prevention guidance

Prevention of infective endocarditis in at-risk patients: how should dentists proceed in 2024?

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