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Myths of Dental-Induced Endocarditis

Myths of Dental-Induced Endocarditis Abstract Although the latest (1990) American Heart Association recommendations for the prevention of bacterial endocarditis are by far the simplest yet, many physicians and dentists still do not comply with them. One of the reasons for this low compliance is that many clinicians rely on "myths" of dental-induced endocarditis prevention. To educate clinicians on endocarditis and its prevention, the myths of dental-induced endocarditis prevention are analyzed. Myth 1: For the most part, physicians and dentists are aware of and comply with American Heart Association guidelines on antibiotic prophylaxis for prevention of infective endocarditis. Myth 2: Most cases of bacterial endocarditis of oral origin are caused by dental procedures. Myth 3: American Heart Association antibiotic regimens give almost total protection against endocarditis after dental procedures. Myth 4: Antibiotics should be administered for any dental procedure that causes bleeding. Myth 5: If a patient was receiving recent antibiotic therapy before the dental procedure, there is no need to change the dose or the antibiotic before the dental procedure. Myth 6: The risk of endocarditis is almost always greater than the risk of antibiotic toxic effects. Myth 7: Parenteral antibiotics before dental procedures are preferable for most patients with high-risk conditions (eg, prosthetic heart valves and previous history of endocarditis). Myth 8: All patients with mitral valve prolapse should routinely receive antibiotic prophylaxis for dental procedures. Myth 9: Clinicians should err on the positive side of antibiotic prophylaxis to prevent lawsuits. (Arch Intern Med. 1994;154:137-144) References 1. Wahl MJ, Wahl PT. Prevention of infective endocarditis: an update for clinicians . Quintessence Int. 1993;24:171-175. 2. Gold MJ. Cure rates and long-term prognosis . In: Kaye D, ed. Infective Endocarditis . 2nd ed. New York, NY: Raven Press; 1992:455-464. 3. Nissen H, Nielsen PF, Frederiksen M, Helleberg C, Nielsen JS. Native valve infective endocarditis in the general population: a 10-year survey of the clinical picture during the 1980s . Eur Heart J. 1992;13:872-877. 4. Scheld WM, Sande MA. Endocarditis and intravascular infections . In: Mandell GL, Douglas RG, Bennett JE, eds. Principles and Practice of Infectious Disease . 3rd ed. New York, NY: Churchill Livingstone; 1990:670-706. 5. Durack DT. Prophylaxis of infective endocarditis . In: Mandell GL, Douglas RG, Bennett JE, eds. Principles and Practice of Infectious Disease . 3rd ed. New York, NY: Churchill-Livingstone; 1990: 716-721. 6. Chemoprophylaxis for infective endocarditis: faith, hope, and charity challenged . Lancet. 1992;339: 525-526.Crossref 7. Bor DH, Himmelstein DU. Endocarditis prophylaxis for patients with mitral valve prolapse: a quantitative analysis . Am J Med. 1984;76:711-717.Crossref 8. Dajani AS, Bisno AL, Chung KJ, et al. Prevention of bacterial endocarditis: recommendations by the American Heart Association . JAMA. 1990; 264:2919-2922.Crossref 9. Brooks SL. Survey of compliance with American Heart Association guidelines for prevention of bacterial endocarditis . J Am Dent Assoc. 1980;101:41-43. 10. Sadowsky D, Kunzel C. Clinician compliance and the prevention of bacterial endocarditis . J Am Dent Assoc. 1984;109:425-428. 11. Hashway T, Stone LJ. Antibiotic prophylaxis of subacute bacterial endocarditis for adult patients by dentists in Dade County, Florida . Circulation . 1982;66:1110-1113.Crossref 12. Sadowsky D, Kunzel C. 'Usual and customary' practice versus the recommendations of experts: clinician noncompliance in the prevention of bacterial endocarditis . J Am Dent Assoc. 1989; 118:175-180. 13. Nelson CL, Van Blaricum CS. Physician and dentist compliance with American Heart Association guidelines for prevention of bacterial endocarditis . J Am Dent Assoc. 1989;118:169-173. 14. Gould IM. Current prophylaxis for prevention of infective endocarditis . Br Dent J. 1990;168:409-410.Crossref 15. Tan SY, Gill G. Selection of dental procedures for antibiotic prophylaxis against infective endocarditis . J Dent. 1992;20:375-376.Crossref 16. Holbrook WP, Willey RF, Shaw TRD. Prophylaxis of infective endocarditis: problems in practice . Br Dent J. 1983;154:36-39.Crossref 17. van der Meer JTM, van Wijk W, Thompson J, Valkenburg HA, Michel MF. Awareness of need and actual use of prophylaxis: lack of patient compliance in the prevention of bacterial endocarditis . J Antimicrob Chemother. 1992;29:187-194.Crossref 18. Starkebaum M, Durack D, Beeson P. The 'incubation period' of subacute bacterial endocarditis . Yale J Biol Med. 1977;50:49-58. 19. Bayliss R, Clarke C, Oakley C, Somerville W, Whitfield AGW. The teeth and infective endocarditis . Br Heart J. 1983;50:506-512.Crossref 20. Guntheroth WG. How important are dental procedures as a cause of infective endocarditis? Am J Cardiol. 1984;54:797-801.Crossref 21. Jack SS. Current Estimates From the National Health Interview Survey: United States, 1980 . Hyattsville, Md: National Center for Health Statistics; 1981. Dept of Health and Human Seervices publication PHS-82-1567; data from the National Health Survey, series 10, No. 139. 22. van der Meer JTM, van Wijk W, Thompson J, Vandenbroucke JP, Valkenburg HA, Michel MF. Efficacy of antibiotic prophylaxis for prevention of native-valve endocarditis . Lancet. 1992;339: 135-139.Crossref 23. Durack DT, Littler WA. Failure of 'adequate' penicillin therapy to prevent bacterial endocarditis after tooth extraction . Lancet. 1974;2:846-847.Crossref 24. Eng RHK, Smith SM, Goldstein EJC, Miyasaki KT, Quah SE, Buccini F. Failure of vancomycin prophylaxis and treatment for Actinobacillus actinomycetemcomitans endocarditis . Antimicrob Agents Chemother. 1986;29:699-700.Crossref 25. van der Bijl P, Meresky LS. Failures of endocarditis prophylaxis: selective review of the literature and a case report . Ann Dent. Summer 1991;L( (1) ):5-8. 26. Durack DT, Kaplan EL, Bisno AL. Apparent failures of endocarditis prophylaxis: analysis of 52 cases submitted to a national registry . JAMA. 1983; 250:2318-2322.Crossref 27. McCarthy VP, Cho CT, Diehl AM, Ramsey BW. Bacterial endocarditis due to penicillin-resistant Streptococcus viridans . Clin Pediatr. 1979;18: 263-266.Crossref 28. Leviner E, Tzukert AA, Benoliel R, Baram O, Sela MN. Development of resistant oral viridans streptococci after administration of prophylactic antibiotics: time management in the dental treatment of patients susceptible to infective endocarditis . Oral Surg. 1987;64:417-420.Crossref 29. Denning DW, Cassidy M, Dougall A, Hillis WS. Failure of single dose amoxycillin as prophylaxis against endocarditis . BMJ. 1984;289:1499-1500.Crossref 30. Parillo JE, Borst GC, Mazur MH, et al. Endocarditis due to resistant viridans streptococci during oral penicillin chemoprophylaxis . N Engl J Med. 1979;300:296-300.Crossref 31. Green JG, Haisch L. Infective endocarditis and antibiotic prophylaxis failure following an endodontic procedure . Gen Dent. (March) -April 1988: 130-133. 32. Drucker DB, Jolly M. Sensitivity of oral microorganisms to antibiotics . Br Dent J. 1971;131: 442-444.Crossref 33. Pallasch TJ. A critical appraisal of antibiotic prophylaxis . Int Dent J. 1989;39:183-196. 34. Harrison GAJ, Stross WP, Rubin MP, Davies RM, Speller DCE. Resistance in oral streptococci after repeated three-dose erythromycin prophylaxis . J Antimicrob Chemother. 1985;15:471-479.Crossref 35. Harrison GAJ, Rubin MP, Davies RM, Speller DCE. Resistance in oral streptococci after repetition of a single-dose amoxycillin prophylactic regimen . J Antimicrob Chemother. 1985;15:501-503.Crossref 36. Kaye D. Prophylaxis for infective endocarditis: an update . Ann Intern Med. 1986;104:419-423.Crossref 37. Simmons NA, Cawson RA, Eykyn SJ, et al. Antibiotic prophylaxis of infective endocarditis: recommendations from the Endocarditis Working Party of the British Society for Antimicrobial Chemotherapy . Lancet. 1990;335:88-89.Crossref 38. Simmons NA, Cawson RA, Clarke C, et al. The antibiotic prophylaxis of infective endocarditis: report of a Working Party of the British Society for Antimicrobial Chemotherapy . Lancet. 1982; 2:1323-1326. 39. Shulman ST, Amren DP, Bisno AL, et al. Prevention of bacterial endocarditis: a statement for health professionals by the Committee on Rheumatic Fever and Infective Endocarditis of the Council on Cardiovascular Disease in the Young . Circulation . 1984;70:1123A-1127A. 40. Department of Toxicology, ADA Health Foundation Research Institute. Antibiotic interference with oral contraceptives . J Am Dent Assoc. 1991:122 ( (12) ):79. 41. Pogrel MA, Welsby PD. The dentist and prevention of infective endocarditis . Br Dent J. 1975; 139:12-16.Crossref 42. van der Meer JTM, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in the Netherlands, II: antecedent procedures and use of prophylaxis . Arch Intern Med. 1992; 152:1869-1873.Crossref 43. Council on Dental Therapeutics. Prevention of bacterial endocarditis: a committee report of the American Heart Association . J Am Dent Assoc. 1985;110:98-100. 44. Petersdorf RG. Antimicrobial prophylaxis of bacterial endocarditis: prudent caution or bacterial overkill? Am J Med. 1978;65:220-223.Crossref 45. Fekete T. Controversies in the prevention of infective endocarditis related to dental procedures . Dent Clin North Am. 1990;34:79-90. 46. Shanson DC, Cannon P, Wilks M. Amoxycillin compared with penicillin V for the prophylaxis of dental bacteraemia . J Antimicrob Chemother. 1978;4:431-436.Crossref 47. Preventing endocarditis . BMJ. 1979;1:290-291.Crossref 48. Piecuch JF. Antibiotic prophylaxis for the dental patient with cardiovascular disease . J Conn State Dent Assoc. 1984;58:83-85. 49. Clemens JD, Ransohoff DF. A quantitative assessment of pre-dental antibiotic prophylaxis for patients with mitral-valve prolapse . J Chronic Dis. 1984;37:531-544.Crossref 50. Hickey AJ, MacMahon SW, Wilcken DEL. Mitral valve prolapse and bacterial endocarditis: when is antibiotic prophylaxis necessary? Am Heart J. 1985;109:431-435.Crossref 51. Bender IB. Dental bacteremia and its relationship to bacterial endocarditis: preventive measures . Compend Contin Educ Dent. 1989;10: 472-483. 52. Simmons NA, Ball AP, Cawson RA, et al. Antibiotic prophylaxis and infective endocarditis . Lancet. 1992;339:1292-1293.Crossref 53. Shanson DC, Ashford RFU, Singh J. High-dose oral amoxycillin for preventing endocarditis . BMJ. 1980;280:446.Crossref 54. Malinverni R, Overholser CD, Bille J, Glauser MP. Antibiotic prophylaxis of experimental endocarditis after dental extractions . Circulation. 1988;77: 182-187.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Myths of Dental-Induced Endocarditis

Wahl, Michael J.
Archives of Internal Medicine , Volume 154 (2) – Jan 24, 1994
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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420020037005
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Abstract

Abstract Although the latest (1990) American Heart Association recommendations for the prevention of bacterial endocarditis are by far the simplest yet, many physicians and dentists still do not comply with them. One of the reasons for this low compliance is that many clinicians rely on "myths" of dental-induced endocarditis prevention. To educate clinicians on endocarditis and its prevention, the myths of dental-induced endocarditis prevention are analyzed. Myth 1: For the most part, physicians and dentists are aware of and comply with American Heart Association guidelines on antibiotic prophylaxis for prevention of infective endocarditis. Myth 2: Most cases of bacterial endocarditis of oral origin are caused by dental procedures. Myth 3: American Heart Association antibiotic regimens give almost total protection against endocarditis after dental procedures. Myth 4: Antibiotics should be administered for any dental procedure that causes bleeding. Myth 5: If a patient was receiving recent antibiotic therapy before the dental procedure, there is no need to change the dose or the antibiotic before the dental procedure. Myth 6: The risk of endocarditis is almost always greater than the risk of antibiotic toxic effects. Myth 7: Parenteral antibiotics before dental procedures are preferable for most patients with high-risk conditions (eg, prosthetic heart valves and previous history of endocarditis). Myth 8: All patients with mitral valve prolapse should routinely receive antibiotic prophylaxis for dental procedures. Myth 9: Clinicians should err on the positive side of antibiotic prophylaxis to prevent lawsuits. (Arch Intern Med. 1994;154:137-144) References 1. Wahl MJ, Wahl PT. Prevention of infective endocarditis: an update for clinicians . Quintessence Int. 1993;24:171-175. 2. Gold MJ. Cure rates and long-term prognosis . In: Kaye D, ed. Infective Endocarditis . 2nd ed. New York, NY: Raven Press; 1992:455-464. 3. Nissen H, Nielsen PF, Frederiksen M, Helleberg C, Nielsen JS. Native valve infective endocarditis in the general population: a 10-year survey of the clinical picture during the 1980s . Eur Heart J. 1992;13:872-877. 4. Scheld WM, Sande MA. Endocarditis and intravascular infections . In: Mandell GL, Douglas RG, Bennett JE, eds. Principles and Practice of Infectious Disease . 3rd ed. New York, NY: Churchill Livingstone; 1990:670-706. 5. Durack DT. Prophylaxis of infective endocarditis . In: Mandell GL, Douglas RG, Bennett JE, eds. Principles and Practice of Infectious Disease . 3rd ed. New York, NY: Churchill-Livingstone; 1990: 716-721. 6. Chemoprophylaxis for infective endocarditis: faith, hope, and charity challenged . Lancet. 1992;339: 525-526.Crossref 7. Bor DH, Himmelstein DU. Endocarditis prophylaxis for patients with mitral valve prolapse: a quantitative analysis . Am J Med. 1984;76:711-717.Crossref 8. Dajani AS, Bisno AL, Chung KJ, et al. Prevention of bacterial endocarditis: recommendations by the American Heart Association . JAMA. 1990; 264:2919-2922.Crossref 9. Brooks SL. Survey of compliance with American Heart Association guidelines for prevention of bacterial endocarditis . J Am Dent Assoc. 1980;101:41-43. 10. Sadowsky D, Kunzel C. Clinician compliance and the prevention of bacterial endocarditis . J Am Dent Assoc. 1984;109:425-428. 11. Hashway T, Stone LJ. Antibiotic prophylaxis of subacute bacterial endocarditis for adult patients by dentists in Dade County, Florida . Circulation . 1982;66:1110-1113.Crossref 12. Sadowsky D, Kunzel C. 'Usual and customary' practice versus the recommendations of experts: clinician noncompliance in the prevention of bacterial endocarditis . J Am Dent Assoc. 1989; 118:175-180. 13. Nelson CL, Van Blaricum CS. Physician and dentist compliance with American Heart Association guidelines for prevention of bacterial endocarditis . J Am Dent Assoc. 1989;118:169-173. 14. Gould IM. Current prophylaxis for prevention of infective endocarditis . Br Dent J. 1990;168:409-410.Crossref 15. Tan SY, Gill G. Selection of dental procedures for antibiotic prophylaxis against infective endocarditis . J Dent. 1992;20:375-376.Crossref 16. Holbrook WP, Willey RF, Shaw TRD. Prophylaxis of infective endocarditis: problems in practice . Br Dent J. 1983;154:36-39.Crossref 17. van der Meer JTM, van Wijk W, Thompson J, Valkenburg HA, Michel MF. Awareness of need and actual use of prophylaxis: lack of patient compliance in the prevention of bacterial endocarditis . J Antimicrob Chemother. 1992;29:187-194.Crossref 18. Starkebaum M, Durack D, Beeson P. The 'incubation period' of subacute bacterial endocarditis . Yale J Biol Med. 1977;50:49-58. 19. Bayliss R, Clarke C, Oakley C, Somerville W, Whitfield AGW. The teeth and infective endocarditis . Br Heart J. 1983;50:506-512.Crossref 20. Guntheroth WG. How important are dental procedures as a cause of infective endocarditis? Am J Cardiol. 1984;54:797-801.Crossref 21. Jack SS. Current Estimates From the National Health Interview Survey: United States, 1980 . Hyattsville, Md: National Center for Health Statistics; 1981. Dept of Health and Human Seervices publication PHS-82-1567; data from the National Health Survey, series 10, No. 139. 22. van der Meer JTM, van Wijk W, Thompson J, Vandenbroucke JP, Valkenburg HA, Michel MF. Efficacy of antibiotic prophylaxis for prevention of native-valve endocarditis . Lancet. 1992;339: 135-139.Crossref 23. Durack DT, Littler WA. Failure of 'adequate' penicillin therapy to prevent bacterial endocarditis after tooth extraction . Lancet. 1974;2:846-847.Crossref 24. Eng RHK, Smith SM, Goldstein EJC, Miyasaki KT, Quah SE, Buccini F. Failure of vancomycin prophylaxis and treatment for Actinobacillus actinomycetemcomitans endocarditis . Antimicrob Agents Chemother. 1986;29:699-700.Crossref 25. van der Bijl P, Meresky LS. Failures of endocarditis prophylaxis: selective review of the literature and a case report . Ann Dent. Summer 1991;L( (1) ):5-8. 26. Durack DT, Kaplan EL, Bisno AL. Apparent failures of endocarditis prophylaxis: analysis of 52 cases submitted to a national registry . JAMA. 1983; 250:2318-2322.Crossref 27. McCarthy VP, Cho CT, Diehl AM, Ramsey BW. Bacterial endocarditis due to penicillin-resistant Streptococcus viridans . Clin Pediatr. 1979;18: 263-266.Crossref 28. Leviner E, Tzukert AA, Benoliel R, Baram O, Sela MN. Development of resistant oral viridans streptococci after administration of prophylactic antibiotics: time management in the dental treatment of patients susceptible to infective endocarditis . Oral Surg. 1987;64:417-420.Crossref 29. Denning DW, Cassidy M, Dougall A, Hillis WS. Failure of single dose amoxycillin as prophylaxis against endocarditis . BMJ. 1984;289:1499-1500.Crossref 30. Parillo JE, Borst GC, Mazur MH, et al. Endocarditis due to resistant viridans streptococci during oral penicillin chemoprophylaxis . N Engl J Med. 1979;300:296-300.Crossref 31. Green JG, Haisch L. Infective endocarditis and antibiotic prophylaxis failure following an endodontic procedure . Gen Dent. (March) -April 1988: 130-133. 32. Drucker DB, Jolly M. Sensitivity of oral microorganisms to antibiotics . Br Dent J. 1971;131: 442-444.Crossref 33. Pallasch TJ. A critical appraisal of antibiotic prophylaxis . Int Dent J. 1989;39:183-196. 34. Harrison GAJ, Stross WP, Rubin MP, Davies RM, Speller DCE. Resistance in oral streptococci after repeated three-dose erythromycin prophylaxis . J Antimicrob Chemother. 1985;15:471-479.Crossref 35. Harrison GAJ, Rubin MP, Davies RM, Speller DCE. Resistance in oral streptococci after repetition of a single-dose amoxycillin prophylactic regimen . J Antimicrob Chemother. 1985;15:501-503.Crossref 36. Kaye D. Prophylaxis for infective endocarditis: an update . Ann Intern Med. 1986;104:419-423.Crossref 37. Simmons NA, Cawson RA, Eykyn SJ, et al. Antibiotic prophylaxis of infective endocarditis: recommendations from the Endocarditis Working Party of the British Society for Antimicrobial Chemotherapy . Lancet. 1990;335:88-89.Crossref 38. Simmons NA, Cawson RA, Clarke C, et al. The antibiotic prophylaxis of infective endocarditis: report of a Working Party of the British Society for Antimicrobial Chemotherapy . Lancet. 1982; 2:1323-1326. 39. Shulman ST, Amren DP, Bisno AL, et al. Prevention of bacterial endocarditis: a statement for health professionals by the Committee on Rheumatic Fever and Infective Endocarditis of the Council on Cardiovascular Disease in the Young . Circulation . 1984;70:1123A-1127A. 40. Department of Toxicology, ADA Health Foundation Research Institute. Antibiotic interference with oral contraceptives . J Am Dent Assoc. 1991:122 ( (12) ):79. 41. Pogrel MA, Welsby PD. The dentist and prevention of infective endocarditis . Br Dent J. 1975; 139:12-16.Crossref 42. van der Meer JTM, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in the Netherlands, II: antecedent procedures and use of prophylaxis . Arch Intern Med. 1992; 152:1869-1873.Crossref 43. Council on Dental Therapeutics. Prevention of bacterial endocarditis: a committee report of the American Heart Association . J Am Dent Assoc. 1985;110:98-100. 44. Petersdorf RG. Antimicrobial prophylaxis of bacterial endocarditis: prudent caution or bacterial overkill? Am J Med. 1978;65:220-223.Crossref 45. Fekete T. Controversies in the prevention of infective endocarditis related to dental procedures . Dent Clin North Am. 1990;34:79-90. 46. Shanson DC, Cannon P, Wilks M. Amoxycillin compared with penicillin V for the prophylaxis of dental bacteraemia . J Antimicrob Chemother. 1978;4:431-436.Crossref 47. Preventing endocarditis . BMJ. 1979;1:290-291.Crossref 48. Piecuch JF. Antibiotic prophylaxis for the dental patient with cardiovascular disease . J Conn State Dent Assoc. 1984;58:83-85. 49. Clemens JD, Ransohoff DF. A quantitative assessment of pre-dental antibiotic prophylaxis for patients with mitral-valve prolapse . J Chronic Dis. 1984;37:531-544.Crossref 50. Hickey AJ, MacMahon SW, Wilcken DEL. Mitral valve prolapse and bacterial endocarditis: when is antibiotic prophylaxis necessary? Am Heart J. 1985;109:431-435.Crossref 51. Bender IB. Dental bacteremia and its relationship to bacterial endocarditis: preventive measures . Compend Contin Educ Dent. 1989;10: 472-483. 52. Simmons NA, Ball AP, Cawson RA, et al. Antibiotic prophylaxis and infective endocarditis . Lancet. 1992;339:1292-1293.Crossref 53. Shanson DC, Ashford RFU, Singh J. High-dose oral amoxycillin for preventing endocarditis . BMJ. 1980;280:446.Crossref 54. Malinverni R, Overholser CD, Bille J, Glauser MP. Antibiotic prophylaxis of experimental endocarditis after dental extractions . Circulation. 1988;77: 182-187.Crossref

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Archives of Internal Medicine – American Medical Association

Published: Jan 24, 1994

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