Thornhill, M. orcid.org/0000-0003-0681-4083, Gibson, T., Yoon, F. et al. (5 more authors) (2023) Endocarditis, invasive dental procedures, and antibiotic prophylaxis efficacy in US Medicaid patients. Oral Diseases. ISSN 1354-523X
Abstract
Objective
Antibiotic prophylaxis is recommended before invasive dental procedures to prevent endocarditis in those at high risk, but supporting data are sparse. We therefore investigated any association between invasive dental procedures and endocarditis, and any antibiotic prophylaxis effect on endocarditis incidence.
Subjects and Methods
Cohort and case-crossover studies were performed on 1,678,190 Medicaid patients with linked medical, dental, and prescription data.
Results
The cohort study identified increased endocarditis incidence within 30 days of invasive dental procedures in those at high risk, particularly after extractions (OR 14.17, 95% CI 5.40–52.11, p < 0.0001) or oral surgery (OR 29.98, 95% CI 9.62–119.34, p < 0.0001). Furthermore, antibiotic prophylaxis significantly reduced endocarditis incidence following invasive dental procedures (OR 0.20, 95% CI 0.06–0.53, p < 0.0001). Case-crossover analysis confirmed the association between invasive dental procedures and endocarditis in those at high risk, particularly following extractions (OR 3.74, 95% CI 2.65–5.27, p < 0.005) and oral surgery (OR 10.66, 95% CI 5.18–21.92, p < 0.0001). The number of invasive procedures, extractions, or surgical procedures needing antibiotic prophylaxis to prevent one endocarditis case was 244, 143 and 71, respectively.
Conclusions
Invasive dental procedures (particularly extractions and oral surgery) were significantly associated with endocarditis in high-risk individuals, but AP significantly reduced endocarditis incidence following these procedures, thereby supporting current guideline recommendations.
Metadata
Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2023 The Authors. Oral Diseases published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution License, (http://creativecommons.org/licenses/by/4.0/) which permits use, distribution and reproduction in any medium, provided the original work is properly cited. | ||||||
Keywords: | Infective endocarditis; antibiotic prophylaxis; dental procedures; guidelines; prevention; Medicaid; health disparities | ||||||
Dates: |
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Institution: | The University of Sheffield | ||||||
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Clinical Dentistry (Sheffield) | ||||||
Funding Information: |
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Depositing User: | Symplectic Sheffield | ||||||
Date Deposited: | 19 Apr 2023 16:12 | ||||||
Last Modified: | 03 May 2023 10:24 | ||||||
Status: | Published online | ||||||
Publisher: | Wiley | ||||||
Refereed: | Yes | ||||||
Identification Number: | https://doi.org/10.1111/odi.14585 |