Aitor de Gea Rico
Whipps Cross Hospital, London
Title: Infective endocarditis of presumed dental origin and the NICE guidelines: An updated overview
Biography
Biography: Aitor de Gea Rico
Abstract
Introduction: Antimicrobial prophylaxis against Infective Endocarditis (IE) in patients undergoing interventional procedures is no longer recommended in the UK. The National Institute for Health and Care Excellence (NICE) Guidelines published in 2008 has been object of significant controversy within the scientific community. A number of recently published case reports add on argument to the debate. We present a case of IE following dental treatment for which NICE guidelines were followed.
Case report: A 59-year-old gentleman presented with a 1 week history of general malaise, nausea, loss of appetite and lethargy after minimal exertion. Known mitral valve prolapse was reported, and an initial differential diagnosis included subacute bacterial endocarditis. An echocardiogram and Streptococcus mitis growth in the blood cultures supported the likely diagnosis. He was referred to the Oral and Maxillofacial Surgery Department where his previous dental history revealed dental treatment 1 month before admission. In line with the current guidelines, the patient did not receive antibiotics pre-operatively.
Discussion: Dental professionals should be able to recognise the signs and symptoms of IE. It is important to remain informed about such a pathological entity and be aware of its diagnosis and management. Patients with certain cardiac conditions who are at increased risk of developing IE still remain at risk, despite the recent change in the NICE guidelines. The promotion of preventive dentistry and medicine is crucial to reduce the overall risk of IE. The incidence of IE since this radical change in practice remains to be quantified and act upon. Involving patients in informed decision-making and individualization of cases when antibiotic prophylaxis is considered seem to be a more ethical approach.