Dental News - Endocarditis risk: Many German dentists ignore guidelines

Endocarditis risk: Many German dentists ignore guidelines

Gross pathology of subacute bacterial endocarditis involving mitral valve. (DTI/Photo courtesy of wikimedia)

Dental Tribune International

Tue. 25. September 2012

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BAD OEYNHAUSEN, Germany: German patients with congenital or acquired heart disease are advised to submit a cardiological examination pass to their dentist prior to treatment to prevent possible endocarditis. According to a recent study, many dentists in the country do not follow the current guidelines of the German Cardiac Society, which recommend antibiotic therapy for high-risk patients before periodontal treatment.

Before 2007, this antibiotic prophylaxis was also recommended for patients with a relatively low risk. According to Prof. Cornelia Piper, a cardiologist and researcher at the Heart and Diabetes Center NRW in Bad Oeynhausen, the new guidelines have not so far helped to raise the awareness of dentists, particularly in terms of ways to prevent life-threatening inflammatory endocarditis. Instead, restricting precautionary measures to high-risk patients has led to fewer antibiotic therapies not only for moderate-risk patients but also for high-risk patients.

Endocarditis is inflammation of the inside lining of the heart chambers and valves. If left untreated, the disease is fatal. In Western Europe, endocarditis is rare in people with healthy hearts and it is treatable with antibiotics. However, people with congenital or acquired heart disease, especially those who have had a heart valve replacement, carry an increased risk of developing endocarditis.

“Periodontal treatment can become highly dangerous for these high-risk patients,” said Piper. “Owing to numerous dental procedures, Gram-positive bacteria from the gingival pockets can enter the bloodstream. The bacteria then tend to adhere to the heart valves and multiply, and endocarditis is the result.”

The guidelines of the German Cardiac Society recommend that high-risk patients undergo antibiotic therapy—a so-called endocarditis prophylaxis—before dental treatment. “Taken one hour before the periodontal treatment, the antibiotic ensures that only small amounts of bacteria at most can settle at the heart valves. Thus, the risk of inflammation of the lining is significantly reduced,” Piper explained.

“It has been shown that the safest means for patients is the use of the patient pass, which should contain appropriate guidance and be presented to the treating dentist,” added Piper. “It is also under consideration whether an antibiotic prophylaxis is recommendable for patients with a moderate risk for endocarditis. However, at the moment, there is no sufficient data for this.”