Management of the orthodontic patient 'at risk' from infective endocarditis.

There are no clear guidelines for the application of current antibiotic prophylactic regimes to orthodontic patients at risk from infective endocarditis. In order to ascertain current practice, a survey on various aspects of the management of orthodontic patients at risk from infective endocarditis was undertaken. Questionnaires were sent to all 1038 members of the British Society for the Study of Orthodontics and the British Association of Orthodontists. A total of 518 replies were received, 480 (46%) of which were completed in full and analysed. Eight cases of infective endocarditis associated with orthodontic treatment over a 44-year period were reported. The majority of respondents underestimated the number of at risk patients likely to be encountered over a 5-year period. Most orthodontists routinely contact the medical practitioner (62%) or hospital consultant (65%) for advice on the prescription of prophylactic antibiotics. Only 58 (12%) claimed to have refused orthodontic treatment for at risk patients. The majority of respondents advise the use of antibiotic prophylaxis for band placement and removal and manipulation of an unerupted tooth. A high standard of oral hygiene must be established prior to orthodontic treatment for at risk patients. Antibiotic prophylaxis in orthodontics should be used for procedures which cause gingival trauma eg band placement and removal. The daily use of a chlorhexidine mouthwash during treatment and prior to appliance adjustment is recommended.