Infective endocarditis and the dental practitioner: a review of 53 cases involving litigation.

ABSTRACT

OBJECTIVE: To review episodes of infective endocarditis involving dental procedures that have resulted in litigation and to determine if any clinical recommendations can be obtained. DESIGN: 13-year retrospective study. INTERVENTION Patient records were analysed to identify the probable cause of infective endocarditis. All were judged to be caused by dental manipulations on the basis of dental procedure, cardiac pathology, infecting micro-organism and time between onset of infection and dental manipulation. MAIN OUTCOME MEASURES: Cases were analysed to check if appropriate national guidelines on antibiotic prophylaxis were followed. Status of patient dental records was also evaluated. RESULTS: Dental procedures implicated in infective endocarditis were exodontia (23), scaling (21), root canal therapy with extra-canal instrumentation (7) and minor oral surgery (2). No medical history was recorded in 10 patients. In a further 31 medical history was inadequate or out of date. Dentists involved with these cases failed to give prophylactic antibiotics (48), prescribed incorrect antibiotics (2), or gave antibiotics at inappropriate times (2). There was one episode of prophylaxis with amoxycillin failing despite it being given correctly. CONCLUSIONS: If litigation is to be avoided dental practitioners must keep accurate dental records, take an appropriate medical history that is kept up to date and adhere to national guidelines on antibiotic prophylaxis.