New advice from the Scottish Dental Clinical Effectiveness Programme and independently from NICE recommends that patients with a heightened risk of infective endocarditis are not offered antibiotic prophylaxis routinely for invasive dental procedures, but it may be an option for patients requiring special consideration after consultation with their cardiologist. Whilst the Faculty of General Dental Practice has expressed concern in the past, it now agrees with advice.
“New advice from the Scottish Dental Clinical Effectiveness Programme recommends that patients with a heightened risk of infective endocarditis are not offered antibiotic prophylaxis routinely.“
Dr Nick Palmer, editor of the FGDP(UK)’s Antimicrobial Prescribing For General Dental Practitioners, said: “For over 10 years the recommendations in NICE CG64, which apply to all healthcare professionals including cardiologists, have remained the same. 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 invasive 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. SDCEP’s implementation advice re-emphasises the NICE CG64 recommendations, but notes that there are a very small number of dental patients that may require special consideration for antibiotic prophylaxis. 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.”