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Updated advice for dentists: antibiotic prophylaxis against infective endocarditis

30 August 2018


The Scottish Dental Clinical Effectiveness Programme (SDCEP) has published new implementation advice on Antibiotic Prophylaxis Against Infective Endocarditis, which is available to be used by all dentists across the UK.


What's in the new implementation advice?

The advice supports the implementation of the NICE Clinical Guideline 64 Prophylaxis against infective endocarditis,  which states that antibiotic prophylaxis should not be provided "routinely" prior to invasive dental treatment for patients who have an increased risk of infective endocarditis. 

The SDCEP implementation advice offers guidance about which individual patients might be at increased risk and consequently should be considered for non-routine management.  

The SDCEP advice also emphasises the importance of including patients in decisions about their care. It provides support for dentists in discussions with patients and their cardiololgists, who together will identify when there may be a case for special consideration for antibiotic prophylaxis/non-routine management. 

SDCEP has also produced supporting tools, including a patient information leaflet, for dental teams to download and print.


What is the BDA's view on the implementation guidance?

The BDA's Health and Science Committee commented on a draft version of the guidance and requested amendments earlier this year. 

We believe most dental professionals are aware of the guidance and treat patients appropriately, but SDCEP's guidance will help ensure a more consistent approach to patient care across the UK. 

The key messages of the original NICE guidance published in 2008, were that antibiotic prophylaxis should not be used for dental procedures to prevent infective endocarditis, and that patients at increased risk should be advised of the importance of oral health. 

However, in 2016 NICE revised the guidance and clarified that prophylaxis should not be used 'routinely' for dental patients at increased risk of infective endocarditis, and clinicians should apply their clinical judgement on a patient by patient basis.

In response to SDCEP's consultation, we expressed concerns at the absence of any reference in their guidance to the risks of antimicrobial resistance, which dentists should discuss with patients if they are considering prescribing prophylactic antibiotics to prevent infective endocarditis. 


Combating the problem of antibiotic resistance in dentistry

We are campaigning on the issue of antimicrobial resistance in dentistry and have called on government for a requirement for appropriately funded emergency-time to treat patients effectively, as well as a range of other measures to combat the problem.


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