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Dental health and endocarditis prevention

Endocarditis is a rare, life-threatening inflammation of the lining of the heart muscle and its valves. It is caused by a bacterial infection. Although it can occur in anyone, it is much more common in people with certain heart conditions and in those who have had it before. If your risk is high, you can take steps to reduce it.

How have endocarditis prevention guidelines changed?

In very rare cases, bacteria in the mouth may trigger endocarditis in people at higher risk. This is what happens: bacteria found in tooth plaque may multiply and cause gingivitis (gum disease). If not treated, this may become advanced. The gums become inflamed (red and swollen) and often bleed during tooth brushing, flossing or certain dental procedures involving the manipulation of the gums. When gums bleed, the bacteria can enter the bloodstream and can infect other parts of the body. In the case of endocarditis, this affects the inner lining of the heart and the surfaces of the heart valves. The bacteria stick to these surfaces and create growths or pockets of bacteria. These growths (called vegetations) may then prevent the valves from functioning properly, making the heart less efficient and in some cases leading to heart failure.

In 2008, the National Institute for Health and Clinical Excellence (NICE) issued new guidelines to help prevent endocarditis. After reviewing published studies, NICE found that only a small number of cases of infective endocarditis might be prevented by giving antibiotics to cover dental procedures, and that the risks of resistance to antibiotics were greater than the risk of infection. Because of this, the new recommendations state that even people at risk of infective endocarditis who are undergoing dental procedures should not be given preventative (prophylactic) antibiotics. 

The guidelines define those people who are considered at risk of infective endocarditis. These include people with acquired valvular heart disease with narrowed or leaking valves; people with valve replacements; people with structural congenital heart disease, whether corrected surgically or not; those with previous infective endocarditis; and people with hypertrophic cardiomyopathy (an abnormal thickening of the heart muscle). In such people at risk, the guidelines recommend that professionals and patients should be aware of the potential for infection, and that any episodes of infection should be investigated and treated promptly to reduce the risk of endocarditis developing.

Who should receive antibiotics before having a dental treatment?

NICE recommendations are not to offer routine antibiotics to patients undergoing dental treatments; instead GPs and specialists should inform people about the risks and benefits of antibiotics, the symptoms of infective endocarditis and the risks of non-medical invasive procedures, such as body piercing and tattooing.

Is there anything else I can do to reduce my risk of infective endocarditis?

  • Tell your dentist if your health has changed since your last visit. Always let your dentist know if you have had heart or blood vessel (vascular) surgery within the past six months. Also tell them if you have been diagnosed with other heart conditions.
  • Make sure your dentist has a complete list of the names and dosages of your medications, both prescription and over-the-counter.
  • Make sure your dentist has the names and phone numbers of all of your doctors. Your dentist may want to consult with your GP or specialist about your dental care plan and medication choices.
  • Practice good oral hygiene. Brush your teeth at least twice a day; floss at least once a day. Good oral and dental health is very important for patients at risk of endocarditis.


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