Are Prophylactic Antibiotics Before Dental Procedures Necessary to Prevent Infective Endocarditis?

Dental office
Dental office
People with prosthetic heart valves may be more susceptible to oral streptococcal infective endocarditis following invasive dental procedures.

A French national study of patients with prosthetic heart valves who underwent invasive dental procedures indicates that such procedures may cause endocarditis infection associated with oral streptococci, as reported in BMJ.

A study of 138,876 adults with prosthetic heart valves examined the frequency of oral streptococcal infective endocarditis via primary discharge diagnosis codes. Researchers also conducted a case crossover study to compare participants’ exposure to invasive dental procedures during a 3-month period with 3 other 3-month control periods for the same individual.

Just under 50% (n=49.9%) of participants underwent at least 1 dental procedure. Researchers found that 103,463 invasive dental procedures were performed, with 50.1% of participants undergoing antibiotic prophylaxis. Over 1.7 years of median follow-up, 267 participants developed infective endocarditis associated with oral streptococci (incidence rate: 93.7 per 100,000 person-years; 95% CI, 82.4-104.9).

Oral streptococcal infective endocarditis preceded by invasive dentistry within a 3-month period only occurred in 5.1% of the participants. The incidence of such infection after an invasive dental procedure was higher, but not statistically higher, in participants who did not receive the recommended antibiotic prophylaxis.

“Results of our 2 studies differed in terms of statistical significance…[h]owever, both indicate the same direction of effect, suggesting that invasive dental procedures may be associated with oral streptococcal infective endocarditis,” the researchers concluded.

The researchers suggest that future studies should consist of international collaborations studying larger numbers of participants to determine with adequate statistical power whether antibiotic prophylaxis is indicated in this patient population.

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Tubiana S, Blotière P-O, Hoen B, et al. Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: nationwide population based cohort and a case crossover study [published online September 7, 2017]. BMJ. doi:10.1136/bmj.j3776