Cardiac Disease & Dental Management for Surgery

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Cardiac Disease and Implementing Dental Management for Surgery

In post 5 of our “Medication and Dental Surgery: How your medical history influences treatment decisions” series we discuss cardiac disease and its impacts on dental management.

In an attempt to prevent an infection such as endocarditis, many cardiac patients have been directed by their cardiologist to receive a specific antibiotic therapy before they receive dental treatment, however the evidence to support the effectiveness of this practice is weak and current standards of evidence-based medicine call into question the need for, and the effectiveness of prophylactic antibiotics for patients with a number of cardiac problems.

Indeed the risk of suffering from side effects of the antibiotics including allergy responses and gastrointestinal effects appear to be greater than the likelihood of benefiting from the medication.

There are a number of conflicting medical guidelines at this time concerning which patients need to receive antibiotics before invasive medical or dental procedures to prevent endocarditis developing in susceptible patients.   It is important therefore to define who are susceptible patients; this is covered in the next few paragraphs.

The 2006 British Society of Antimicrobial Chemotherapy, 2007 American Heart Associationand the 2008 UK Department of Health National Institute for Clinical Excellence (NICE) Guidelines all list slightly different groups who are considered susceptible to endocarditis.

It is agreed that patients with a history of previous endocarditis or patients who have prosthetic heart valves should receive appropriate antibiotics before invasive medical or dental procedures that may lead to a bacteraemia.   The American guidelines also include heart transplant patients with valvulopathy.  However, the 2008 UK NICE guidelines most recently have advised that the provision of antibiotics purely to prevent endocarditis is not necessary for any patients as there is no evidence base to indicate that such a practice has any beneficial effect.

The most recent Australian guidelines (2008) advise the provision of prophylactic antibiotics for patients who have a previous history of:

  • endocarditis
  • prosthetic heart valves
  • prosthetic material used to repair heart valves
  • heart transplant patients with subsequent valvulopathy with full consultation with the cardiologist
  • Rheumatic Heart Disease and are in a high risk group for endocarditis, in particular patients in low socio-economic groups
  • Some patients with congenital heart disease may also need prophylactic antibiotics.This would be discussed with the cardiologist.

Dr Priestland will use the recommended antibiotics if your cardiac history indicates there is a need or if your cardiologist advises this is recommended.

What is endocarditis?

Infective endocarditis is a relatively uncommon condition that arises from a bacterial infection of the damaged heart lining called the endocardium.   All surfaces of the heart chambers and the heart valves are covered by endocardium. It is when this surface is damaged that a patient can suffer from a condition called endocarditis.   Endocarditis is initiated by colonisation of the damaged endocardial surface by bacteria circulating in the blood stream (bacteraemia).  A bacteraemia may occur as a result of an invasive medical or dental procedure.

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