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. 2001 Jan;85(1):66–68. doi: 10.1136/heart.85.1.66

Dental procedures in children with severe congenital heart disease: a theoretical analysis of prophylaxis and non-prophylaxis procedures

Z Al-Karaawi 1, V Lucas 1, M Gelbier 1, G Roberts 1
PMCID: PMC1729563  PMID: 11119466

Abstract

OBJECTIVE—To estimate the cumulative exposure to bacteraemia from dental procedures currently recommended for antibiotic prophylaxis and compare this with cumulative exposure from dental procedures not recommended for prophylaxis.
DESIGN—Retrospective analysis.
SETTING—University and teaching hospital maxillofacial and dental department.
PATIENTS—136 children with severe congenital cardiac disease attending for dental treatment between 1993 and 1998 and for whom full records were available. Each dental procedure was tallied.
MAIN OUTCOME MEASURES—Cumulative exposure per annum to "non-prophylaxis procedures"; cumulative exposure per annum to "prophylaxis procedures".
RESULTS—Cumulative exposure to bacteraemia from prophylaxis procedures was not significantly greater than from non-prophylaxis procedures.
CONCLUSIONS—The data raise important questions about the appropriateness of current guidelines for antibiotic prophylaxis of bacterial endocarditis.


Keywords: congenital heart disease; dental treatment; cumulative risk; endocarditis

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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., 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]
  2. Cawson R. A. Infective endocarditis as a complication of dental treatment. Br Dent J. 1981 Dec 15;151(12):409–414. doi: 10.1038/sj.bdj.4804724. [DOI] [PubMed] [Google Scholar]
  3. Dajani A. S., Taubert K. A., Wilson W., Bolger A. F., Bayer A., Ferrieri P., Gewitz M. H., Shulman S. T., Nouri S., Newburger J. W. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA. 1997 Jun 11;277(22):1794–1801. [PubMed] [Google Scholar]
  4. Durack D. T., Lukes A. S., Bright D. K. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994 Mar;96(3):200–209. doi: 10.1016/0002-9343(94)90143-0. [DOI] [PubMed] [Google Scholar]
  5. Everett E. D., Hirschmann J. V. Transient bacteremia and endocarditis prophylaxis. A review. Medicine (Baltimore) 1977 Jan;56(1):61–77. [PubMed] [Google Scholar]
  6. Farrington F. H. The incidence of transient bacteremia following pulpotomies on primary teeth. ASDC J Dent Child. 1973 May-Jun;40(3):175–184. [PubMed] [Google Scholar]
  7. Franco E., Saunders C. P., Roberts G. J., Suwanprasit A. Dental disease, caries related microflora and salivary IgA of children with severe congenital cardiac disease: an epidemiological and oral microbial survey. Pediatr Dent. 1996 May-Jun;18(3):228–235. [PubMed] [Google Scholar]
  8. Guntheroth W. G. How important are dental procedures as a cause of infective endocarditis? Am J Cardiol. 1984 Oct 1;54(7):797–801. doi: 10.1016/s0002-9149(84)80211-8. [DOI] [PubMed] [Google Scholar]
  9. HARVEY W. P., CAPONE M. A. Bacterial endocarditis related to cleaning and filling of teeth with particular reference to the inadequacy of present day knowledge and practice of antibiotic prophylaxis for all dental procedures. Am J Cardiol. 1961 Jun;7:793–798. doi: 10.1016/0002-9149(61)90397-6. [DOI] [PubMed] [Google Scholar]
  10. Heimdahl A., Hall G., Hedberg M., Sandberg H., Söder P. O., Tunér K., Nord C. E. Detection and quantitation by lysis-filtration of bacteremia after different oral surgical procedures. J Clin Microbiol. 1990 Oct;28(10):2205–2209. doi: 10.1128/jcm.28.10.2205-2209.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hoffman J. I. Incidence of congenital heart disease: I. Postnatal incidence. Pediatr Cardiol. 1995 May-Jun;16(3):103–113. doi: 10.1007/BF00801907. [DOI] [PubMed] [Google Scholar]
  12. Kaye D. Prophylaxis for infective endocarditis: an update. Ann Intern Med. 1986 Mar;104(3):419–423. doi: 10.7326/0003-4819-104-3-419. [DOI] [PubMed] [Google Scholar]
  13. 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]
  14. Pogrel M. A., Welsby P. D. The dentist and prevention of infective endocarditis. Br Dent J. 1975 Jul 1;139(1):12–16. doi: 10.1038/sj.bdj.4803485. [DOI] [PubMed] [Google Scholar]
  15. Pollard M. A., Curzon M. E. Dental health and salivary Streptococcus mutans levels in a group of children with heart defects. Int J Paediatr Dent. 1992 Aug;2(2):81–85. doi: 10.1111/j.1365-263x.1992.tb00014.x. [DOI] [PubMed] [Google Scholar]
  16. Roberts G. J., Gardner P., Longhurst P., Black A. E., Lucas V. S. Intensity of bacteraemia associated with conservative dental procedures in children. Br Dent J. 2000 Jan 22;188(2):95–98. doi: 10.1038/sj.bdj.4800399. [DOI] [PubMed] [Google Scholar]
  17. Roberts G. J., Holzel H. S., Sury M. R., Simmons N. A., Gardner P., Longhurst P. Dental bacteremia in children. Pediatr Cardiol. 1997 Jan-Feb;18(1):24–27. doi: 10.1007/s002469900103. [DOI] [PubMed] [Google Scholar]
  18. Roberts G. J., Radford P., Holt R. Prophylaxis of dental bacteraemia with oral amoxycillin in children. Br Dent J. 1987 Mar 7;162(5):179–182. doi: 10.1038/sj.bdj.4806069. [DOI] [PubMed] [Google Scholar]
  19. Roberts G. J., Simmons N. B., Longhurst P., Hewitt P. B. Bacteraemia following local anaesthetic injections in children. Br Dent J. 1998 Sep 26;185(6):295–298. doi: 10.1038/sj.bdj.4809795. [DOI] [PubMed] [Google Scholar]
  20. Roberts G. J., Watts R., Longhurst P., Gardner P. Bacteremia of dental origin and antimicrobial sensitivity following oral surgical procedures in children. Pediatr Dent. 1998 Jan-Feb;20(1):28–36. [PubMed] [Google Scholar]
  21. van der Meer J. T., Thompson J., Valkenburg H. A., Michel M. F. Epidemiology of bacterial endocarditis in The Netherlands. I. Patient characteristics. Arch Intern Med. 1992 Sep;152(9):1863–1868. doi: 10.1001/archinte.152.9.1863. [DOI] [PubMed] [Google Scholar]

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