Infective endocarditis and the dental practitioner: a review of 53 cases involving litigation.
OBJECTIVE
To review episodes of infective endocarditis involving dental procedures that have resulted in litigation and to determine if any clinical recommendations can be obtained.


METHODS
13-year retrospective study.


METHODS
Patient records were analysed to identify the probable cause of infective endocarditis. All were judged to be caused by dental manipulations on the basis of dental procedure, cardiac pathology, infecting micro-organism and time between onset of infection and dental manipulation.


METHODS
Cases were analysed to check if appropriate national guidelines on antibiotic prophylaxis were followed. Status of patient dental records was also evaluated.


RESULTS
Dental procedures implicated in infective endocarditis were exodontia (23), scaling (21), root canal therapy with extra-canal instrumentation (7) and minor oral surgery (2). No medical history was recorded in 10 patients. In a further 31 medical history was inadequate or out of date. Dentists involved with these cases failed to give prophylactic antibiotics (48), prescribed incorrect antibiotics (2), or gave antibiotics at inappropriate times (2). There was one episode of prophylaxis with amoxycillin failing despite it being given correctly.


CONCLUSIONS
If litigation is to be avoided dental practitioners must keep accurate dental records, take an appropriate medical history that is kept up to date and adhere to national guidelines on antibiotic prophylaxis.
Martin
M V
MV
Department of Clinical Dental Sciences, University of Liverpool.
Butterworth
M L
ML
Longman
L P
LP
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003729:Dental Care / Q000009:adverse effects*; D003792:Dental Records; D012534:Dental Scaling / Q000009:adverse effects; D003815:Dentists / Q000331:legislation & jurisprudence*; D004697:Endocarditis, Bacterial / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008487:Medical History Taking; D008875:Middle Aged; D013511:Minor Surgical Procedures / Q000009:adverse effects; D009055:Mouth / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012390:Root Canal Therapy / Q000009:adverse effects; D013997:Time Factors; D014081:Tooth Extraction / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D010406:Penicillins; D000658:Amoxicillin