Prevention of infective endocarditis in dental procedures

Background:

In 2007, the American Heart Association published updated evidence-based guidelines on the recommended use of antibiotic prophylaxis to prevent infective endocarditis (IE) due to viridans group streptococci (VGS) in cardiac patients undergoing invasive procedures.

The 2007 guidelines significantly narrowed the underlying conditions for which antibiotic prophylaxis was recommended, leaving only 4 categories believed to confer the greatest risk of adverse outcomes.

The purpose of this update is to examine the range evidence for the acceptance and impact of the 2007 recommendations in VGS IE and, if necessary, make revisions based on this evidence.

Methods and results:

A writing group was formed consisting of experts in the prevention and treatment of infective endocarditis, including members of the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics, as well as the American Heart Association.

The MEDLINE database was searched for English-language articles on compliance with the 2007 guideline recommendations and the frequency and morbidity or mortality of VGS IE following publication of the 2007 guidelines.

Overall, there was good overall knowledge of the 2007 guidelines, but variable compliance with the recommendations. There was no convincing evidence that the frequency, morbidity or mortality of VGS IE has increased since 2007.

Summary of findings and suggestions
Key results

Viridans group streptococcal (VGS ) infective endocarditis ( IE) is much more likely to develop as a result of transient VGS bacteremia attributable to routine daily activities, such as chewing food and brushing teeth, than as a result of a surgical procedure. dental.
Antibiotic prophylaxis ( AP) could prevent an extremely small number of cases of VGS IE for a dental procedure, even if prophylaxis is 100% effective.
If PA for a dental procedure is effective in preventing a very small number of cases of VGS IE, it should be suggested only for those patients at highest risk of adverse outcomes of VGS IE.
There is no convincing evidence of increased frequency or morbidity or mortality from IE VGS in patients at low, moderate, or high risk of adverse outcomes since the publication of the 2007 document.
PA for a dental procedure is not suggested solely on the basis of an increased lifetime risk of acquiring VGS IE

Suggestions

PA for a dental procedure that involves manipulation of gingival tissues, the periapical region of teeth, or perforation of the oral mucosa is suggested only for patients with the highest risk of adverse outcome from VGS IE.
Maintaining good oral health and regular access to dental care are considered more important for preventing VGS IE than PA for dental treatment.
procedure. We suggest that patients undergo biannual dental exams when such care is available.
Shared decision making is important between patients and healthcare providers. There may be cases where a healthcare provider and a patient disagree with the suggestions in the 2021 scientific statement.
In these cases, the healthcare provider should be familiar with and understand the 2021 suggestions to adequately inform patients of the risks and benefits of PA for a dental procedure so that an informed decision can be made.

Conclusions:

Based on a review of the available evidence, there are no recommended changes to the 2007 VGS IE prevention guidelines.

We continue to recommend VGS IE prophylaxis only for patient categories at highest risk for adverse outcomes, while emphasizing the critical role of good oral health and regular access to dental care for all.

Randomized controlled studies are needed to determine whether antibiotic prophylaxis is effective against VGS IE to refine recommendations.

Prevention of infective endocarditis in dental procedures

Antibiotic prophylaxis for invasive dental procedures is suggested only for high-risk patients with conditions such as prosthetic heart valve