Why dentists should look after your heart: Rules introduced in 2008 bar routine use of antibiotics during dental appointments… even though they could reduce risk of infective endocarditis
Over the past decade, a silent and deadly bug has been infecting rising numbers of people in the UK.
New research shows that since 2009, annual cases of infective endocarditis — an infection of the heart which kills more than a third of those affected within a year — have soared by 86 per cent.
And experts fear official guidance is depriving those most in danger — the million or so Britons with defective or artificial heart valves — of the drugs that could protect them and even save their lives.
Infective endocarditis occurs when bacteria from bleeding gums, skin infections or even catheters inserted as part of a procedure, get into the bloodstream and travel to the heart.
In roughly a third of infections, the bacteria are thought to get into the bloodstream from the mouth. This can be as a result of poor dental hygiene [File photo]
The bacteria, the most common of which is Staphylococcus aureus, found on the skin, then slowly attack the heart.
Early symptoms are flu-like but, left untreated, the damage to the heart can cause heart failure (where it struggles to pump blood around the body) and stroke.
But what could be causing this relentless year-on-year increase?
Scientists say Britain’s ageing population is probably a factor: older hearts are less able to withstand destructive bacteria. Doctors may also be getting better at recognising the condition.
But there is also a theory that it is a consequence of rules introduced in 2008 by the National Institute for Health and Care Excellence (NICE), the NHS spending watchdog, that barred the routine preventative use of antibiotics for patients most at risk of infective endocarditis when they had a dental appointment.
In roughly a third of infections, the bacteria are thought to get into the bloodstream from the mouth. This can be as a result of poor dental hygiene, which can lead to bleeding gums, but may also be due to accidental bleeds during routine dental procedures.
On reaching the heart, the bacteria destroy the valves. They can also trigger strokes, as fragments of diseased tissue break free and clog up blood vessels to the brain.
While the risks of infection during dental work were very low, dentists used to give the drugs routinely to certain patients.
A single dose of antibiotics for those at high risk (a group that includes at least a million people born with defective heart valves and 100,000 with artificial valves) would be enough to prevent any problem.
However, NICE ruled there was insufficient clinical evidence to support antibiotic use when science was — and still is —grappling with the problem of mounting drug resistance.
But research published in The Lancet in April suggests some patients may have paid a very high price for that decision.
On reaching the heart, the bacteria destroy the valves. They can also trigger strokes, as fragments of diseased tissue break free and clog up blood vessels to the brain [File photo]
Experts at Sheffield University studied data on infection rates and found that between 1998 and 2009 — before the NICE ruling — about 27 in every million people got infective endocarditis. By 2019, this had risen to 50 people per million, or about 3,000 a year, almost all of them in high-risk groups.
Yet in the U.S. and other parts of Europe, where antibiotics are still given out by dentists, cases have remained comparatively stable.
Research leader Dr Martin Thornhill says: ‘We cannot be sure what part the NICE recommendation played in the large increase here but it is very worrying.’