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British Heart Foundation
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Endocarditis warning card

“Happy new year”

Do BHF still do the endocarditis warning cards at all? I was just curious and do you still have to have antibiotics before any dental treatment?

I’ve been reading some very serious stories that have been due to dental treatment and followed by serious complications afterwards.

Cheers Ali

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The advice from the National Istitute of Clinical Excellence (body who states what doctors can or can not perscribe) clearly states no antibiotics before dental work for heart patients. (There are very few exceptions to this).

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NICE advises antibiotics for patients who have had their heart valves replaced see below for the summary of the guidance published 2016.

'Patients at high risk: replacement heart valves or prior endocarditis.

Patients at moderate risk: native valve disease.

High-risk dental procedure: extraction, deep descaling.

Antibiotic prophylaxis: indicated for people at high risk having high-risk dental procedures. Record details of consent process in the dental notes. Use amoxicillin 3 g or clindamycin 600 mg orally 1 hour before.

Other advice: dental surveillance 6-monthly (high-risk patients) or annually (medium-risk patients); avoid tattoos and intravenous drug use.

Warning: consider infective endocarditis with unresolving fever or night sweats, especially with systemic symptoms. Consider blood cultures before starting an antibiotic course.'

bjgp.org/content/66/650/460.3

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ok fair enough. The last guidance that I bothered checking was 2008 when it was a categoric no Because my high risk procedure was 2014. In 2017 my (post valve replacement) my cardiologist gave same advice. No antibiotics before dental work- so I assumed it had not changed.

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The change was not widely publicised by NICE so it will take sometime for the update to get through to all the relevant healthcare professionals who need to know.

Of course by the time that happens the guidelines could have been changed again!

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Check with your dentist and if they are in any doubt they should contact your GP or specialist.

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Hi Ali. I’ve never heard of a Endocarditis warning card!

I have had endocarditis in the past so I do take antibiotics before any dental work apart from a check up. My cardiologist agreed to this. I took them all of my life for dental work until they stopped giving them out a few years ago.

Sue.

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I have had endocarditis and my cardiologist insists on me having a visit to the hygienist every twelve weeks. This treatment is preceded by antibiotics one hour beforehand, which I used to take myself at home, but on the last two visits I have had to call with the hygienist one hour beforehand to take them and to be seen to take them.

I’ve never had a card, although I know that, once someone has endocarditis they are more likely to have a repeat of this illness.

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bjgpopen.org/content/bjgpoa...

I found this as it was an interesting question I believe this is further clarification of the NICE apparent blanket ban by inserting the ‘not routinely’. It suggests that those with a valve replacement or previous infective endocarditis can have them based on their risk appetite or their cardiologists clinical judgement. If you are in that situation (having valve or previous IE) and you don’t think your dentist had consulted your cardiologist and you want the reassurance of antibiotics I would ask your cardiologist.

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Just when I was about two weeks away from bypass surgery I developed an abscessed tooth. Despite the fact that I was both diabetic and awaiting cardiac surgery I was refused antibiotics. I was also referred to an oral surgeon for extraction. It was about four weeks till I saw the oral surgeon who had not been passed my medical history and had also been told the wrong tooth! Afterwards he refused to prescribe antibiotics saying the source had been removed and citing (not) NICE guidelines. Two weeks later still in considerable discomfort and with a fair amount of swelling I was prescribed antibiotics, which cleared things up in about three days. One minute they were giving antibiotics to patients with a cold, now NICE guidelines seem to override common sense!

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Hi

Thanks for all your replies and I’m clear now on all of it.

Doing sone research BHF used to do a warning card which you had to call up for but has now been removed from their website.

Ali

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bhf.org.uk/informationsuppo...

This is the warning card I was on about

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I had my second AVR at the end of 2017 and I have to have antibiotics if I have anything intrusive done at the dentist, such as extraction, but I also have the added problem of no spleen, so it’s on my records that I have to have them.

Wendy

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I had endocarditis and valve replacement in 2017, the infection entered my body after I lost a filling. I had a valve replacement as a stenosed bicuspid aortic valve was discovered at the same time.

My dentist discussed my situation with an expert group of dentists. As I result I have penicillin one hour pre hygienist appointment. I see the hygienist every 12 weeks and the dentist twice a year.

After a recent routine echo my cardiologist wrote to me with the results but also wrote to stress the importance of dental checks in my case.

Best wishes

Mary

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My cardiologist insists on it. I got endocarditis as a result of a poorly fitted crown. Because of the NICE guidelines the dentist wanted a letter from the cardiologist. Once they got that there was no problem. You only need the cover for invasive work.

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