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Br Dent J. 2016 Jan 22;220(2):51-6. doi: 10.1038/sj.bdj.2016.49.

Guidelines on prophylaxis to prevent infective endocarditis.

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Department of Oral &Maxillofacial Medicine and Surgery, The School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA; Adjunct Professor of Oral Medicine, Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
Taunton and Somerset NHS Trust.
Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
Department of Oral and Maxillofacial Surgery, Guy's and St Thomas' Hospitals, London.
Great Ormond Street Hospital for Children, London.
Guy's and St Thomas' Hospitals, London.


Infective endocarditis is a devastating disease with high morbidity and mortality. The link to oral bacteria has been known for many decades and has caused ongoing concern for dentists, patients and cardiologists. Since 2008, the UK has been out of step with the rest of the world where antibiotic prophylaxis is recommended for high-risk patients undergoing invasive dental procedures. Recent evidence that identified an increase in endocarditis incidence prompted a guideline review by NICE and the European Society for Cardiology--which produces guidance for the whole of Europe. Despite reviewing the same evidence they reached completely opposing conclusions. The resulting conflict of opinions and guidance is confusing and poses difficulties for dentists, cardiologists and their patients. Recent changes in the law on consent, however, may provide a patient-centred and pragmatic solution to these problems. This Opinion piece examines the evidence and opposing guidance on antibiotic prophylaxis in the context of the recent changes in the law on consent and provides a framework for how patients at risk of endocarditis might be managed in practice.

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