>Dear list members,
>Someone recently asked me about the outlook for Mitral Valve
>Prolapse (MVP)
>* Is antibiotic prophylaxis indicated for dental work and
>instrumentation such as catheters? Reading between the lines, there
>does seem to be a slightly higher risk of endocarditis for MVP rather
>than entirely normal heart valves, but nothing like as high as for
>patients with prosthetic valves, or a history of rheumatic fever.
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I am just reproducing the summary of an article which I included in the
Decebmer issue of JSCAN (a professional news letter for local circulation)
which may be relevant for the above question. Any feed back will be
appreciated.
Cheers,
Badri
Dental and cardiac risk factors for infective endocarditis. A
population-based, case control study. Strom BL, Abrutyn E, Berlin JA et al.
Ann Intern Med 1998;129:761-769.
In this era of evidence based medicine (EBM), long-held clinical doctrines
are being questioned. Readers may well remember the medical school teaching
that antibiotic prophylaxis should be given to risk groups before dental
procedures to prevent infective endocarditis. This is still the current
teaching, though its effectiveness in humans has not been proven. The risk
group for prophylaxis include those with cardiac valve abnormalities. This
case control study from Philadelphia questions the value of antibiotic
prophylaxis in patients with valvular abnormalities. The authors
interviewed 273 patients with community-acquired infective endocarditis and
matched neighborhood controls. Information on demographic variables, host
risk factors, and dental treatment was obtained from medical records and the
interview. There was no difference in the frequency of dental treatment
between cases and neighborhood controls in the preceding three months. 38%
of the cases knew of their cardiac lesions as compared to 6% of the
controls. Of the cases and controls who knew of their condition, 20.2% of
cases and 23.5% controls had had dental treatment over the last two months.
Case patients more often had a history of mitral valve prolapse, congenital
heart disease, cardiac valvular surgery, rheumatic fever and heart murmur
without other known cardiac abnormalities. The authors concluded that dental
treatment might not be a risk factor for infective endocarditis, even in
patients with valvular abnormalities, but that cardiac valvular
abnormalities are strong risk factors and that physicians should reconsider
the current policies for prophylaxis.
The accompanying editorial puts this study into context and makes practical
recommendations; "The time has come to scale back on prophylaxis against
endocarditis before dental treatment. In the matrix of procedures related to
predisposing conditions, prophylaxis should be downgraded to "not
recommended" for most dental procedures except extractions and gingival
surgery (including implant placement) and for most underlying cardiac
conditions except prosthetic valves and previous endocarditis".
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Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)
Assistant Professor and Epidemiologist,
Department of Community Medicine,
UAE University, PO Box 17666, Al Ain,
United Arab Emirates.
Tel: 00 971 3 5039 652
Fax: 00 971 3 672022.
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