Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1993 Jul;70(1):79–83. doi: 10.1136/hrt.70.1.79

Cost effectiveness of prophylaxis in dental practice to prevent infective endocarditis.

I M Gould 1, J K Buckingham 1
PMCID: PMC1025233  PMID: 8038004

Abstract

BACKGROUND--Although antimicrobial prophylaxis for infective endocarditis (IE) is common practice for many dental procedures, there is little information on whether it represents value for money. A study was performed to evaluate the effectiveness of prophylaxis for all at risk patients in routine dental practice with published data from the United Kingdom. METHODS--The risk of contracting infective endocarditis was calculated from published data to find (for high risk patients) both the annual number of deaths attributable to infective endocarditis and the number of high risk dental procedures performed without prophylaxis. Costs are estimated by examining the notes of 63 patients with proved IE during the decade 1980-90. RESULTS--Such prophylaxis is highly cost effective before dental extractions, but its value for other invasive dental procedures is unproved. It was calculated that, for every 10,000 extractions in at risk patients, appropriate prophylaxis will prevent 5.7 deaths and a further 22.85 cases of non-fatal IE. This represents a saving in the costs of hospital care of 289,600 pounds for 10,000 extractions. CONCLUSION--Prophylaxis to prevent IE in at risk patients undergoing dental extraction is highly cost effective. Net savings each year throughout the United Kingdom, that might be achieved by improving the existing proportion of such patients given antibiotics from its present level of about 50% would amount to 2.5 million pounds and would prevent over 50 deaths.

Full text

PDF
79

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bayliss R., Clarke C., Oakley C. M., Somerville W., Whitfield A. G., Young S. E. The microbiology and pathogenesis of infective endocarditis. Br Heart J. 1983 Dec;50(6):513–519. doi: 10.1136/hrt.50.6.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bayliss R., Clarke C., Oakley C., Somerville W., Whitfield A. G. The teeth and infective endocarditis. Br Heart J. 1983 Dec;50(6):506–512. doi: 10.1136/hrt.50.6.506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Buckingham J. K., Gould I. M., Tervitt G., Williams S. Prevention of endocarditis: communication between doctors and dentists. Br Dent J. 1992 Jun 6;172(11):414–415. doi: 10.1038/sj.bdj.4807904. [DOI] [PubMed] [Google Scholar]
  4. Clemens J. D., Ransohoff D. F. A quantitative assessment of pre-dental antibiotic prophylaxis for patients with mitral-valve prolapse. J Chronic Dis. 1984;37(7):531–544. doi: 10.1016/0021-9681(84)90004-3. [DOI] [PubMed] [Google Scholar]
  5. Denning D. W., Cassidy M., Dougall A., Hillis W. S. Failure of single dose amoxycillin as prophylaxis against endocarditis. Br Med J (Clin Res Ed) 1984 Dec 1;289(6457):1499–1500. doi: 10.1136/bmj.289.6457.1499. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Doyle Y. G., Fenlon M. R. Medical screening of 1500 patients in a dental surgery: a prospective study. J R Coll Gen Pract. 1989 Oct;39(327):415–417. [PMC free article] [PubMed] [Google Scholar]
  7. Durack D. T., Kaplan E. L., Bisno A. L. Apparent failures of endocarditis prophylaxis. Analysis of 52 cases submitted to a national registry. JAMA. 1983 Nov 4;250(17):2318–2322. [PubMed] [Google Scholar]
  8. Gould I. M. Chemoprophylaxis for bacterial endocarditis--a survey of current practice in London. J Antimicrob Chemother. 1984 Oct;14(4):379–394. doi: 10.1093/jac/14.4.379. [DOI] [PubMed] [Google Scholar]
  9. Gould I. M. Current prophylaxis for prevention of infective endocarditis. Br Dent J. 1990 May 19;168(10):409–410. doi: 10.1038/sj.bdj.4807219. [DOI] [PubMed] [Google Scholar]
  10. Gould I. M. Prevention of infective endocarditis. Br Dent J. 1988 Jan 23;164(2):31–32. doi: 10.1038/sj.bdj.4806341. [DOI] [PubMed] [Google Scholar]
  11. Hickey A. J., MacMahon S. W., Wilcken D. E. Mitral valve prolapse and bacterial endocarditis: when is antibiotic prophylaxis necessary? Am Heart J. 1985 Mar;109(3 Pt 1):431–435. doi: 10.1016/0002-8703(85)90543-5. [DOI] [PubMed] [Google Scholar]
  12. McGowan D. A. Dental treatment of patients with valvular heart disease. Br Dent J. 1968 Jun;124(11):519–520. [PubMed] [Google Scholar]
  13. McGowan D. A., Nair S., MacFarlane T. W., MacKenzie D. Prophylaxis of experimental endocarditis in rabbits using one or two doses of amoxycillin. Br Dent J. 1983 Aug 6;155(3):88–90. doi: 10.1038/sj.bdj.4805134. [DOI] [PubMed] [Google Scholar]
  14. Moreillon P., Francioli P., Overholser D., Meylan P., Glauser M. P. Mechanisms of successful amoxicillin prophylaxis of experimental endocarditis due to Streptococcus intermedius. J Infect Dis. 1986 Nov;154(5):801–807. doi: 10.1093/infdis/154.5.801. [DOI] [PubMed] [Google Scholar]
  15. Oakley C., Somerville W. Prevention of infective endocarditis. Br Heart J. 1981 Mar;45(3):233–235. doi: 10.1136/hrt.45.3.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Simmons N. A., Ball A. P., Cawson R. A., Eykyn S. J., Littler W. A., McGowan D. A., Oakley C. M., Shanson D. C. Antibiotic prophylaxis and infective endocarditis. Lancet. 1992 May 23;339(8804):1292–1293. doi: 10.1016/0140-6736(92)91618-i. [DOI] [PubMed] [Google Scholar]
  17. Skehan J. D., Murray M., Mills P. G. Infective endocarditis: incidence and mortality in the North East Thames Region. Br Heart J. 1988 Jan;59(1):62–68. doi: 10.1136/hrt.59.1.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Van der Meer J. T., Van Wijk W., Thompson J., Vandenbroucke J. P., Valkenburg H. A., Michel M. F. Efficacy of antibiotic prophylaxis for prevention of native-valve endocarditis. Lancet. 1992 Jan 18;339(8786):135–139. doi: 10.1016/0140-6736(92)90207-j. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES