Child

DENTISTS- Prevention and treatment of Endocarditis

  • Download our leaflet about endocarditis here

    • For many years patients were advised to have antibiotic cover for dental treatment, this is no longer so.
    • Expert advice now is that what is most important is good oral health.
    • Similarly, antibiotic cover is no longer recommended routinely for procedures involving the airways, the gastrointestinal system or the urogenital system.

    You can read about the 2008 NICE recommendations in detail on the NICE website

  • Infective endocarditis and what you can do to avoid it

    • Endocarditis is a rare infection of the inside the heart or the main arteries.
    • It most commonly affects one or more of the heart valves but may also occur around holes between the heart chambers, at the site of abnormalities in the walls of arteries or at the site of previous heart or arterial surgery.
    • It is a serious condition and can cause major damage to the heart valves and may even cause stroke or death.
    • Most endocarditis occurs in patients already known to have heart abnormalities.
    • Most patients with congenital heart disease are at increased risk of getting endocarditis.
    • The only exceptions being isolated atrial septal defects or patients who have had completely curative treatment.

    ADVICE FOR DENTISTS

    The safest option for dental work is via local anaesthetic but if the treatment cannot be performed with the child awake a general anaesthetic will be necessary.

    Anaesthetic advice
    For patients who require a general anaesthetic for dental treatment, the patients with the following simple cardiac lesions can have their treatment performed in the local District General Hospital:

    • Patent Foramen Ovale (PFO) or Atrial Septal Defect (ASD) with no volume loading
    • Restrictive Ventricular Septal Defects (VSD) without failure
    • Patent Ductus Arteriosus (PDA) pre- or post-repair
    • Repaired Atrial Septal Defect or Ventricular Septal Defect
    • Mild Pulmonary Stenosis (<3m/s) (with ECHO in last 6 months)
    • Child under screening with normal heart.

    If the patient has a more complicated cardiac condition, the advice as to whether the patient can be treated locally or at the specialist centre will have to be given on an individual basis based on the patient’s up to date medical condition.

    If you require advice about elective dental treatment then please contact Dr J Scheffczik, Paediatric Cardiac Anaesthetist based at Leeds General Infirmary for advice:

    Dr J Scheffczik email: j.scheffczik@nhs.net

    If the patient requires urgent dental treatment with general anaesthetic please contact the paediatric cardiac anaesthetist on call or the paediatric cardiologist on call via the hospital switchboard at Leeds General Infirmary. Tel 0113 2432799

  • Recognising endocarditis

    • Patients with endocarditis develop a temperature and feel generally unwell, with symptoms very similar to having the flu.
    • Flu is very common and usually resolves after about a week.
    • Flu like symptoms with a temperature which persists for longer than a week should be reported to your cardiologist, not just to your GP, so that specialist tests can be carried out to check for endocarditis.
  • Reducing the risk of getting endocarditis

    • Endocarditis can only occur if bacteria get into the bloodstream (called bacteraemia). Although it is not possible to prevent all bacteria getting into the bloodstream, there are some things you can do to reduce the risk of getting endocarditis.
    • Everybody carries bacteria in the mouth. These are usually harmless, but if the teeth or gums become diseased it becomes much easier for large numbers of bacteria to get into the blood, with the risk they may settle in the heart and cause endocarditis.
    • Good dental care and oral hygiene are therefore particularly important to reduce risk of endocarditis.
    • Apart from regular tooth brushing, regular check ups at the dentist are essential to minimise the risk of endocarditis.
    • The dental hygienist at your dental surgery will give advice on how to look after teeth and gums.
  • If you have difficulties finding a dentist

    • Call NHS Direct Tel. 0845 4647, who keep a list of local dentists or
    • Visit the NHS website which keeps a directory of local services www.nhs.uk/servicedirectories

    Other things that risk endocarditis

    • Ear piercing, other body piercings or tattooing can lead to infections which may cause endocarditis.
    • Patients at increased risk of endocarditis are safest avoiding these procedures.