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Beyond the antibiotic prophylaxis of infective endocarditis: the problem of dental surveillance
  1. John B Chambers1,
  2. Mark Dayer2,
  3. Bernard D Prendergast3,
  4. Jonathan Sandoe4,
  5. Stephen Westaby5,
  6. Martin Thornhill6,
  7. on behalf of the British Heart Valve Society
  1. 1Cardiothoracic Centre, Guy's and St Thomas’ Hospitals, London, UK
  2. 2Cardiac Department, Taunton and Somerset NHS Trust, Taunton, UK
  3. 3Department of Cardiology, John Radcliffe Hospital, Oxford, UK
  4. 4Department of Microbiology, University Hospitals, Leeds, UK
  5. 5John Radcliffe Hospital, Oxford, UK
  6. 6University of Sheffield Dental School, Sheffield, UK
  1. Correspondence to Dr John B Chambers, Cardiothoracic Centre, St Thomas’ Hospital, London SE1 7EH, UK; jboydchambers{at}aol.com

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Controversial guidelines by the National Institute for Health and Clinical Excellence (NICE)1 have stimulated useful discussions about antibiotic prophylaxis before dental procedures. However, this should not distract us from an equally important debate about dental surveillance in the UK.

All guidelines including NICE1 and those from the USA,2 ,3 Europe4 and Australia5 ,6 agree that regular dental surveillance is essential to promote good oral hygiene, reduce the need for invasive dental procedures and reduce the risk of infective endocarditis. Around 40% of cases of infective endocarditis are caused by oral bacteria. Although these may enter the circulation during invasive dental procedures there is also evidence that transient bacteraemia with oral organisms occurs during daily activities such as chewing food and tooth brushing. The size and frequency of the bacteraemia are significantly greater in those with poor oral hygiene.7

Despite the unanimity of these guidelines, provision of dental surveillance in the UK is suboptimal. The 2011 GP patient survey8 found that 40% had not asked for a National Health Service (NHS) appointment in the previous …

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