Dentists Meet Antibiotic Guidelines for High-Risk Cardiac Patients

Dentistry Today


Dentists and oral surgeons are in good compliance with guidelines issued by the American Heart Association (AHA) in 2007 for prophylactic antibiotic use prior to invasive dental procedures, reports the Rochester Epidemiology Project, a collaboration of medical and dental care providers in Minnesota and Wisconsin who link medical, dental, and surgical procedures with prescriptions and other healthcare data with patient agreement for medical research. 

Prior to 2007, the AHA guidelines recommended prophylactic antibiotics for patients with cardiac conditions who were at moderate or high risk of developing infective endocarditis, a potentially deadly infection of the heart valve. After 2007, the AHA recommended that only high-risk patients receive the antibiotics, which represented a very small fraction of the individuals receiving antibiotics before 2007.

Earlier studies had determined the incidence of infective endocarditis in Olmsted County in Minnesota before and after 2007 using Rochester Epidemiology Project data and found no significant increase in cases of infective endocarditis following the introduction of the updated AHA guidelines. But these studies were limited by their lack of access to dental records. The new research is the first study to examine dental records in such an evaluation.

“The inclusion of dental records in the Rochester Epidemiology Project provides a unique opportunity unlike any population health database in the United States,” said Daniel DeSimone, MD, lead author of the study and an infectious disease and hospital internal medicine physician at the Mayo Clinic.

“The primary criticism of earlier studies was, ‘Are dentists actually following the 2007 AHA guidelines, or do patients continue to receive antibiotics when no longer indicated?’” he said. “How could we prove that dentists were actually following the guidelines, rather than assuming they were? Now we can.”

DeSimone also said that patients face a number of health risks when taking antibiotics. Plus, the overuse of antibiotics can result in increased bacterial resistance, a growing problem in public health. And while the individual cost to patients might be only a few dollars a dose, when added up, moderate-risk patients could spend more than $100 million a year on these antibiotics.

“Using the Rochester Epidemiology Project, we have shown that the new guidelines were very helpful in reducing unnecessary antibiotic use and related issues without an increase in new cases of infective endocarditis,” DeSimone said.

The study was published in Mayo Clinic Proceedings.

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