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Infective Endocarditis is not nice!

NICE (National Institute for Health and Clinical Excellence) has produced a set of guidelines for antibiotic cover (prophylaxis) when going to the dentist.

NICE based their guidelines on various findings and conclusions:

  • inconsistent evidence between procedures and cases of Infective Endocarditis (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.
Since the introduction of the NICE guidelines, dentists and perhaps even GPs may be unlikely to prescribe antibiotics for GUCHs for dental procedures. The guidelines do however emphasise 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.

Anyone with concerns about the guidelines should speak to either their GP or Consultant (or both) to get their advice.

Most importantly, bear in mind the point about day to day exposure to bacteria and the importance of good dental hygiene. Cleaning your teeth at least twice a day and going to the dentist every six months may help to avoid IE.

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