Professor of Translational Research in Dentistry, Unit of Oral and Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
Professor of Cardiology, Guy´s and St Thomas´ Hospital, London and Chair of Cardiology, Cleveland Clinic, London, UK.
Br Dent J. 2024 May;236(9):709-716. doi: 10.1038/s41415-024-7355-2. Epub 2024 May 10.
National Institute for Health and Care Excellence (NICE) guidelines are ambiguous over the need for patients at increased risk of infective endocarditis (IE) to receive antibiotic prophylaxis (AP) prior to invasive dental procedures (IDPs), and this has caused confusion for patients and dentists alike. Moreover, the current law on consent requires clinicians to ensure that patients are made aware of any material risk they might be exposed to by any proposed dental treatment and what can be done to ameliorate this risk, so that the patient can decide for themselves how they wish to proceed. The aim of this article is to provide dentists with the latest information on the IE-risk posed by IDPs to different patient populations (the general population and those defined as being at moderate or high risk of IE), and data on the effectiveness of AP in reducing the IE risk in these populations. This provides the information dentists need to facilitate the informed consent discussions they are legally required to have with patients at increased risk of IE about the risks posed by IDPs and how this can be minimised. The article also provides practical information and advice for dentists on how to manage patients at increased IE risk who present for dental treatment.
国家卫生与保健卓越研究所（NICE）的指南在需要接受侵入性牙科治疗（IDP）的感染性心内膜炎（IE）风险增加的患者是否需要接受抗生素预防（AP）的问题上存在模糊性，这给患者和牙医都带来了困惑。此外，目前的同意法要求临床医生确保患者了解任何拟议的牙科治疗可能使他们面临的任何重大风险，以及可以采取哪些措施来减轻这种风险，以便患者自行决定如何继续治疗。本文的目的是为牙医提供有关 IDP 对不同患者群体（普通人群和被定义为 IE 中、高度风险的人群）造成的 IE 风险的最新信息，以及 AP 在降低这些人群 IE 风险方面的有效性数据。这为牙医提供了他们需要的信息，以便在法律上要求他们与 IE 风险增加的患者就 IDP 带来的风险进行知情同意讨论，并探讨如何将风险最小化。本文还为牙医提供了有关如何管理接受 IDP 治疗的 IE 风险增加的患者的实用信息和建议。
