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Michael Sultan: Helping Hearts

New research from The University of Sheffield suggests that dentists should once again prescribe antibiotics to high-risk patients following invasive dental treatment, as this significantly reduces the chance of them developing heart conditions such as infective endocarditis (IE) [1].

Infective endocarditis is a severe heart condition that is caused when bacteria enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel [2]. There are two different types of infective endocarditis – acute and subacute/chronic.

The first develops suddenly and can become fatal in mere days, while the latter type is more of an on-going concern and can take weeks or even months to reach dangerous levels. Because the condition can impact people so differently, fatality rates are difficult to measure, but one study suggests that it is responsible for just over 1 in 1,000 deaths in the general adult population [3].

Men have double the risk of developing the condition compared to women, and although the incidence of IE increases with age, it has higher fatality rates in those aged under 40, which could suggest that people in this age group are unlikely to believe they are suffering from the condition until it is too late.

The link between oral health and heart conditions such as IE has long been suspected. Indeed, it’s thought that 30-40% of cases are caused by bacteria from the oral cavity entering the bloodstream, but there has never been any concrete proof to support this view until now.

So, what does this mean for us as dental professionals?

I think this is definitely an interesting development and something we should be keeping tabs on. We’ve long known that good oral health is the gateway to better overall health, and links like these continually make it crystal clear that we are instrumental in helping people keep on top of their general health.

It does, however, raise an issue about antibiotics and how often we prescribe them. There are studies suggesting that we are already giving out antibiotics far too freely [4] and if we are now being told to do it even more, it does mean that we could, yet again, be leaving ourselves open to further scrutiny. Also, how do we accurately assess high-risk in every case?

While some people will easily fit into this bracket, if we fail to prescribe antibiotics to someone and they then develop IE, will this be our fault? It’s definitely not a black and white issue.

Despite these concerns, I’m optimistic that this research, and us taking action, could make a real difference moving forward. Antibiotics have the power to save lives in these situations, and if we are the difference between someone developing a serious heart condition or not, then prescribing them is the least we can do.


Michael Sultan is the founder and principal of endodontic referral practice EndoCare, and is a regular contributor to Dental Review. For more information, call 020 7224 0999 or visit www.endocare.co.uk 


1] The University of Sheffield. Dentists should give antibiotics to high-risk patients to help prevent life-threatening heart infection. Link: click HERE [Last accessed August 22].

2] Heart.org. Heart Valves and Infective Endocarditis. Link: Click HERE [Last accessed August 22].

3] Ahtela, E. et al. Occurrence of fatal infective endocarditis: a population-based study in Finland. BMC Infectious Diseases volume 19, Article number: 987 (2019).

4] WebMD. Study: Dentists Prescribe Antibiotics Far Too Often. Link: https://www.webmd.com/oral-health/news/20190605/study-dentists-prescribe-antibiotics-far-too-often [Last accessed August 22].

See the original article here: Dental Industry Review