Dental procedures in children with severe congenital heart disease: a theoretical analysis of prophylaxis and non-prophylaxis procedures

doi:10.1136/heart.85.1.66

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Cardiovascular medicine

Dental procedures in children with severe congenital heart disease: a theoretical analysis of prophylaxis and non-prophylaxis procedures Z M Al-Karaawi^b, V S Lucas^a, M Gelbier^b, G J Roberts^c

^a Department of Oral Medicine, Eastman Dental Institute for Oral Healthcare Sciences, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK, ^b Department of Paediatric Dentistry, Eastman Dental Institute, ^c Maxillofacial and Dental Department, Great Ormond Street Hospital for Children, London WC1N 3JH, UK

Correspondence to: Dr Lucas v.lucas{at}eastman.ucl.ac.uk

Accepted 11 September 2000

OBJECTIVE $---$ To estimate the cumulative exposure to bacteraemia from dental procedures currently recommended for antibiotic prophylaxisand compare this with cumulative exposure from dental proceduresnot recommended forprophylaxis.
DESIGN $---$ Retrospectiveanalysis.
SETTING $---$ University and teaching hospital maxillofacial and dentaldepartment.
PATIENTS $---$ 136 children with severe congenital cardiac disease attending for dental treatment between 1993 and 1998 and for whom fullrecords were available. Each dental procedure wastallied.
MAIN OUTCOME MEASURES $---$ Cumulative exposure per annum to "non-prophylaxis procedures"; cumulative exposure per annum to "prophylaxis procedures".
RESULTS $---$ Cumulative exposure to bacteraemia from prophylaxis procedures was not significantly greater than from non-prophylaxisprocedures.
CONCLUSIONS $---$ The data raise important questions about the appropriateness of current guidelines for antibiotic prophylaxis of bacterialendocarditis.

Keywords: congenital heart disease; dental treatment; cumulative risk; endocarditis

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