The 2007 AHA guidelines: issues and discussion concerning clinical dental practice.

Department of Diagnostic Services, Howard University College of Dentistry, Howard University Hospital, USA.
Alpha Omegan 02/2007; 100(4):177-81.
Source: PubMed
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    ABSTRACT: Bacterial endocarditis (BE), a rare heart infection caused by a bacteremia, has frequently been blamed on but rarely caused by dental procedures. Viridans group streptococci are found abundantly in the mouth and the gingival sulcus but have been surpassed by staphylococci as the leading cause of BE. Antibiotic prophylaxis has been recommended before dental procedures in patients at risk for BE, but it remains controversial because studies have failed to show that antibiotic prophylaxis is an effective preventive for BE or that dental procedures are an important cause of BE. The risks and costs of antibiotic prophylaxis, including antibiotic resistance, cross-reactions with other drugs, allergy, anaphylaxis, and even death, may exceed the benefits in preventing BE. The rationale for the use of antibiotic prophylaxis to prevent BE allegedly caused by dental procedure bacteremias must be seriously reexamined based on recent evidence, particularly the absolute risk rates for endocarditis after a given dental procedure.
    Current Infectious Disease Reports 08/2005; 7(4):251-256. DOI:10.1007/s11908-005-0056-3 · 1.68 Impact Factor
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    ABSTRACT: The risks of infective endocarditis (IE) associated with various conditions and procedures are poorly defined. This was a population-based case-control study conducted in 54 Philadelphia, Pa-area hospitals from 1988 to 1990. Community-acquired IE cases unassociated with intravenous drug use were compared with matched community residents. Subjects were interviewed for risk factors. Diagnoses were confirmed by expert review of medical record abstracts with risk factor data removed. Cases were more likely than controls to suffer from prior severe kidney disease (adjusted OR [95% CI]=16.9 [1.5 to 193], P:=0.02) and diabetes mellitus (adjusted OR [95% CI]=2.7 [1.4 to 5.2], P:=0.004). Cases infected with skin flora had received intravenous fluids more often (adjusted OR [95% CI]=6.7 [1.1 to 41], P:=0.04) and had more often had a previous skin infection (adjusted OR [95% CI]=3.5 [0.7 to 17], P:=0.11). No association was seen with pulmonary, gastrointestinal, cardiac, or genitourinary procedures or with surgery. Edentulous patients had a lower risk of IE from dental flora than patients who had teeth but did not floss. Daily flossing was associated with a borderline decreased IE risk. Within the limits of the available sample size, the data showed that IE patients differ from people without IE with regard to certain important risk factors but not regarding recent procedures.
    Circulation 01/2001; 102(23):2842-8. DOI:10.1161/01.CIR.102.23.2842 · 14.43 Impact Factor
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    ABSTRACT: The American Heart Association has recently released a new set of guidelines for prevention of infective endocarditis with major changes and clarifications regarding who should receive antibiotic prophylaxis and who does not require it. The new guidelines are based on the current available evidence and deviate greatly from the previous ones. A summary of the changes and the evidence and philosophy behind this statement is presented in this article. Along with it is the current status of often-conflicting topics on other uses of antibiotic prophylaxis in dentistry. Special notes on heart murmur, patient information sheets, and continuing education questions are also included.
    The Journal of the Michigan Dental Association 10/2007; 89(9):50-6.

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