ANTIBIOTIC PROPHYLAXIS FOR BACTERIAL ENDOCARDITIS: A STUDY OF KNOWLEDGE AND IMPLEMENTATION OF AMERICAN HEART ASSOCIATION GUIDELINES AMONG DENTISTS AND DENTAL HYGIENISTS

BACKGROUND: Knowledge and interpretation of the 2007 American Heart Association (AHA) guidelines regarding infective endocarditis (IE) prophylaxis among the dental community is not well established. Our aim was to determine how dentists and dental hygienists interpret the 2007 AHA guidelines and to assess the degree of heterogeneity in the dental community with respect to IE prophylaxis practice. METHODS: A cross sectional survey was sent to a random sample of 450 dental hygienists and 450 dentists across Alberta. Contact information was obtained from professional organizations. Non responders were resent the survey at 2 weeks and 4 weeks. The survey asked whether the practitioner would recommend IE prophylaxis to (a) a high-risk cardiac patient undergoing a variety of dental procedures, and (b) in the setting of a variety of cardiac lesions for a patient requiring gingival manipulation. Pearson and chi-square tests were used for statistical analysis. Logistic regression was performed to identify demographic factors predictive of failure to follow the AHA guidelines for high-risk patients. P values < 0.05 were considered significant. RESULTS: The survey was completed by 149 hygienists (33%) and 194 dentists (43%). Use of prophylaxis for specific dental procedures was heterogeneous; for example, 46% of hygienists recommended prophylaxis for polishing, 43% did not, and 11% replied “sometimes”. Hygienists were more likely than dentists to inappropriately recommend IE prophylaxis for low-risk lesions including mitral valve prolapse (54% of hygienists, 42% of dentists recommending prophylaxis, p1⁄40.009) and hypertrophic cardiomyopathy (23% vs 15%, p1⁄40.036). Failure to recommend IE prophylaxis was also observed for high-risk lesions, including mechanical valve (only 81% of hygienists and 91% of dentists recommending prophylaxis, p1⁄40.023). On logistic regression analysis, the only factor that was predictive of correctly recommending prophylaxis for high-risk lesions was subjects who responded affirmatively to the question” Did you refer to the 2007 AHA recommendations when completing this survey?” (OR 3.7, p1⁄40.001). CONCLUSION: There is much heterogeneity within the dental community with respect to IE prophylaxis. Dental hygienists are more likely than dentists to recommend IE prophylaxis for low-risk cardiac lesions. Both dentists and hygienists did not consistently recommend prophylaxis for all high-risk cardiac lesions. Therefore, there is a need for continuing professional development among dentists and hygienists regarding IE prophylaxis. Dental practitioners may benefit from keeping the AHA guidelines in a readily accessible place in clinical settings so that they can readily refer to them when needed. WCHRI