Thank you everyone for showing such an interest in this very important debate? So, is the NHS cutting costs ? Surely not ?
acr. Thanks for that link, maybe I'll give it my dentist.
Some pretty bold statements there from Bob H too ? Nowadays I take "massive research that proves" with a pinch of salt. After all massive research proved the Moon is infact made of cheese, did it not ?
Surely leading surgeons know what they're talking about ?
Descaling wouldn't cause massive bleeding nor does having a filling, so by your logic neither would need cover ? And you say Antibiotic cover has no effect on preventing endocarditis anyway ? So is it then just a case of crossing our fingers and hoping for the best ?
How would a doctor test for Endocarditis anyway if it's symptums are so vague for so long ?
Actually most BE comes from things other than dental work, (altho a small amount do come from it) and yes altho it stinks, I think it is a matter of crossing your fingers and hoping for the best. Justin got BE after losing a baby tooth, which the odds of that happening are beyond rare.
BUT since people with valves, cyonotic CHD and previous BE all are on the list to still get antibiotics, He still gets them. Also I believe descaling gets antibiotics,
IF you are interested in their thoughts this might help.
http://circ.ahajournals.org/cgi/content/full/118/8/887
These are the latest updates (2008 in the US) specifically for valve patients (superseced the 2006 BE guidelines)
.3.1. Endocarditis Prophylaxis
Infective endocarditis is a serious illness associated with significant morbidity and mortality. Its prevention by the appropriate administration of antibiotics before a procedure expected to produce bacteremia merits serious consideration. Experimental studies have suggested that endothelial damage leads to platelet and fibrin deposition and the formation of nonbacterial thrombotic endocardial lesions. In the presence of bacteremia, organisms may adhere to these lesions and multiply within the platelet-fibrin complex, leading to an infective vegetation. Valvular and congenital abnormalities, especially those associated with high-velocity jets, can result in endothelial damage, platelet-fibrin deposition, and a predisposition to bacterial colonization. Since 1955, the AHA has made recommendations for prevention of infective endocarditis with antimicrobial prophylaxis before specific dental, gastrointestinal (GI), and genitourinary (GU) procedures in patients at risk for its development. However, many authorities and societies, as well as the conclusions of published studies, have questioned the efficacy of antimicrobial prophylaxis in most situations.
On the basis of these concerns, a writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis, with liaison members representing the American Dental Association, the Infectious Disease Society of America, and the American Academy of Pediatrics. The writing group reviewed the relevant literature regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of the most common organisms that cause infective endocarditis, results of prophylactic studies of animal models of infective endocarditis, and both retrospective and prospective studies of prevention of infective endocarditis. As a result, major changes were made in the recommendations for prophylaxis against infective endocarditis.
The major changes in the updated recommendations included the following:
The committee concluded that only an extremely small number of cases of infective endocarditis may be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 percent effective.
Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis.
For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of either gingival tissue or the periapical region of teeth or perforation of oral mucosa.
Prophylaxis is not recommended solely on the basis of an increased lifetime risk of acquisition of infective endocarditis.
Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a GU or GI tract procedure.
The rationale for these revisions is based on the following:
Infective endocarditis is more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by a dental, GI tract, or GU procedure.
Prophylaxis may prevent an exceedingly small number of cases of infective endocarditis (if any) in individuals who undergo a dental, GI tract, or GU procedure.
The risk of antibiotic-associated adverse effects exceeds the benefit (if any) from prophylactic antibiotic therapy.
Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and is more important than prophylactic antibiotics for a dental procedure to reduce the risk of infective endocarditis.
The AHA Prevention of Infective Endocarditis Committee recommended that prophylaxis be given only to a high-risk group of patients before dental procedures that involve manipulation of either gingival tissue or the periapical region of the teeth or perforation of oral mucosa (Tables 2 to 4). High-risk patients were defined as those patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis, not necessarily those with an increased lifetime risk of acquisition of infective endocarditis. Prophylaxis is no longer recommended for prevention of endocarditis for procedures that involve the respiratory tract unless the procedure is performed in a high-risk patient and involves incision of the respiratory tract mucosa, such as tonsillectomy and adenoidectomy. Prophylaxis is no longer recommended for prevention of infective endocarditis for GI or GU procedures, including diagnostic esophagogastroduodenoscopy or colonoscopy (Table 2). However, in high-risk patients with infections of the GI or GU tract, it is reasonable to administer antibiotic therapy to prevent wound infection or sepsis. For high-risk patients undergoing elective cystoscopy or other urinary tract manipulation who have enterococcal urinary tract infection or colonization, antibiotic therapy to eradicate enterococci from the urine before the procedure is reasonable.
