MedicalResearch.com Interview with:
Daniel C. DeSimone, M.D.
Infectious Diseases Fellowship, Year 2
MedicalResearch.com: What is the background for this study?
Response: For over 50 years, the American Heart Association (AHA) has recommended antibiotics to be given to patients with certain cardiac conditions prior to invasive dental procedures (dental cleanings, extractions, root canals) with the hope to prevent infective endocarditis–a potentially deadly infection of the heart valves. Prevention of this infection was preferred to treatment of an established infection due to its high morbidity and mortality rates. However, in 2007, experts found that there was very little, if any, evidence that showed antibiotics prophylaxis prevented infective endocarditis prior to invasive dental procedures. Given this, the AHA revised its guidelines, significant reducing the number of patients where antibiotic prophylaxis would be given–as routine daily activities such as chewing food, tooth brushing, and flossing were much more likely to cause infective endocarditis than a single dental procedure.
For over 50 years, patients with cardiac conditions that placed them at “moderate risk” and/or “high risk” were to receive antibiotics prior to dental procedures. In 2007, the “moderate risk” group were to no longer receive antibiotic prophylaxis. This is a significantly large proportion of patients–approximately 90% of all patients who would have received antibiotic prophylaxis. Given the drastic changes made in 2007, there was concern among the medical and dental communities about whether we were leaving patients “unprotected” and at risk for infective endocarditis. Thankfully, several population based studies from our group and others across the United States have not shown an increase in the rate of infective endocarditis. However, the question remained, “Are providers following the 2007 AHA guidelines?” and “Are patients still receiving antibiotics prior to dental procedures when its no longer indicated by the guidelines?”.
This was the main focus of our paper. We were able to go into the local dental offices and at the same time, have full access to their medical records. Every dental visit between 2005 and 2015 at their dental office was reviewed; the type of dental visit, whether they received antibiotic prophylaxis or not. In addition, we could confirm their cardiac conditions that would place them at “moderate risk” or “high risk” compared to the general population.
MedicalResearch.com: What are the main findings?
Response: There was a significant reduction in the number of patients with moderate risk cardiac conditions–from approximately 68% receiving antibiotic prophylaxis prior to 2007, down to 8% still receiving antibiotics not in accordance with the 2007 AHA guidelines.
There was a significant reduction in patients at high risk–from 97% pre-2007 to 84% post-2007.
This was an unexpected reduction as antibiotic prophylaxis is still recommended for these high risk patients.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: In a local population, dental providers are in very good compliance with the 2007 AHA infective endocarditis prevention guidelines.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research will need to focus on enrolling further local dental offices into this study. Ideally, a randomized controlled trial to determine whether antibiotic prophylaxis truly prevents infective endocarditis. However, due to the costs and large number of patients in many countries, the chances of this happening is nearly zero.
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Effect of the American Heart Association 2007 Guidelines on the Practice of Dental Prophylaxis for the Prevention of Infective Endocarditis in Olmsted County, Minnesot
DeSimone, Daniel C. et al.
Mayo Clinic Proceedings , Volume 0 , Issue 0 , May 23 2017
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