UK guidance on infective endocarditis (IE) prevention has undergone its most significant change in nearly two decades, and every dentist needs to understand what it means for their clinical practice.
IE is a serious infection of the heart valves. Some 30% of patients die within one year of diagnosis, and survivors face significant long-term health problems (Cahill and Prendergast, 2015). Oral bacteria are implicated in 35-45% of IE cases (Thornhill et al, 2024).
Before 2008, UK guidelines recommended antibiotic prophylaxis (AP) before invasive dental procedures for all patients at increased IE risk.
In 2008, NICE made the contested decision to recommend against all use of AP for IE prevention, stating: ‘Antibiotic prophylaxis against infective endocarditis is not recommended for people undergoing dental procedures.’ Dentists working for the NHS in England and Wales were contractually required to follow NICE guidance, and compliance was high (Dayer et al, 2015).
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