The Faculty of General Dental Practice UK (FGDP(UK)) has endorsed new advice for dentists on the prophylactic use of antibiotics against infective endocarditis (IE). Following the 2016 revision of the National Institute for Health and Care Excellence’s Clinical Guideline (NICE CG64), the Scottish Dental Clinical Effectiveness Programme (SDCEP) has published implementation advice.
“The vast majority of patients at increased risk of infective endocarditis should not be offered prophylaxis. However, for a very small number of patients [‘Patients Requiring Special Consideration’], it may be prudent to consider antibiotic prophylaxis in consultation with the patient and their cardiologist or cardiac surgeon,” the SDCEP advised.
Earlier this year, FGDP(UK) raised some concerns when the advice was in development. But after improvements made as a result of feedback from FGDP(UK) and other organizations, FGDP(UK) and NICE both now support the finalized guidance and believe dentists throughout the United Kingdom will find it useful.
NICE CG64 does not recommend antibiotic prophylaxis for routine invasive dental procedures. The new advice aims to clarify the non-routine circumstances where antibiotic prophylaxis might be justified to prevent IE in such procedures. The advice is accompanied by a patient management flowchart, a discussion points document for use with patients, a patient advice leaflet, and a template letter for contacting a patient’s cardiology consultant or cardiac surgeon.
“For over 10 years, the recommendations in NICE CG64, which apply to all healthcare professionals including cardiologists, have remained the same,” said Nick Palmer, BDS, PhD, editor of FGDP(UK)’s Antimicrobial Prescribing for General Dental Practitioners, which reflects NICE CG 64 and provides evidence-based guidance for antimicrobial prescribing and stewardship.
“These are that patients at increased risk of IE should be advised of the risks and benefits of prophylaxis and that antibiotic prophylaxis is not routinely required for dental procedures. The patient should also be advised of the symptoms of IE, of the importance of maintaining good oral health to reduce their risk of IE, and when to seek expert advice,” Palmer said.
“SDCEP’s implementation advice re-emphasizes the NICE CG64 recommendations, but notes that there are a very small number of dental patients that may require ‘special consideration’ for antibiotic prophylaxis,” said Palmer.
“Importantly, SDCEP’s implementation advice shifts the balance of responsibility for the decision on antibiotic prophylaxis for these patients from the dentist to the patient’s cardiologist and to the patient under Montgomery consent. Dentists should ensure they record in the clinical notes any advice from the patient’s cardiologist and the patient’s consent when a decision is made,” said Palmer.
Antimicrobial Prescribing for General Dental Practitioners is available as an e-book, online, and in hard copy.
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