[Severe complications caused by inattention to endocarditis prevention during dental procedures in adults with congenital heart abnormalities].
OBJECTIVE
Despite new guidelines on antibiotic prophylaxis to prevent bacterial endocarditis there is still confusion about the forms of dental procedures requiring antibiotic prophylaxis. Aim of this study was to determine the incidence of bacterial endocarditis following dental procedures in adults with congenital heart disease during a one-year period, and to assess connections with prophylaxis.


METHODS
The case notes of all adults with congenital heart disease (CHD) treated in hospital during a one year period were analyzed retrospectively to identify cases of endocarditis, and all adults with CHD admitted to hospital for other reasons than endocarditis were interviewed about their knowledge of antibiotic prophylaxis against bacterial endocarditis.


RESULTS
Among the 456 adults with CHD 351 (78%) knew about the need for antibiotic prophylaxis against bacterial endocarditis. Three patients developed endocarditis, in each case after a visit to the dentist. The disease started 11-16 days after dental descaling had been performed without antibiotic covering, one patient developing a brain abscess. The patients had to be treated in the hospital for 42-49 days. Despite presentation by the patient of a leaflet with recommendations for prophylaxis, the dentist refused to give antibiotics.


CONCLUSIONS
Knowledge of adults with CHD is satisfactory but can still be improved. Even more important is better training of dentists who treat patients with CHD with special emphasis on the specific procedures including dental descaling, which require antibiotic prophylaxis.
Vogel
M
M
Abteilung Angeborene Herzfehler, Deutsches Herzzentrum Berlin. drmichaelvogel@doctors.net.uk
Knirsch
W
W
Lange
P E
PE
D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis / Q000592:standards*; D001922:Brain Abscess / Q000209:etiology; D003729:Dental Care / Q000009:adverse effects / Q000592:standards*; D012534:Dental Scaling / Q000009:adverse effects / Q000592:standards*; D003815:Dentists / Q000592:standards; D004497:Education, Dental; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors