Antibiotic prophylaxis for infective endocarditis: Knowledge and implementation of American Heart Association Guidelines among dentists and dental hygienists in Alberta, Canada.

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. The authors' aim was to determine how dentists and dental hygienists interpret the 2007 AHA guidelines.
METHODS: The authors sent a cross-sectional survey to a random sample of 450 dental hygienists and 450 dentists in Alberta, Canada. The survey ascertained whether the practitioner would recommend IE prophylaxis to a high-risk cardiac patient undergoing a variety of dental procedures and for a variety of cardiac lesions in patients requiring gingival manipulation.
RESULTS: One hundred forty-nine hygienists (33%) and 194 dentists (43%) completed the survey. Use of prophylaxis for specific dental procedures was heterogeneous; 43% of hygienists recommended prophylaxis for polishing, 46% 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 versus 42% of dentists recommending prophylaxis; P = .037) and hypertrophic cardiomyopathy (23% versus 15%; P = .057). The authors also observed a failure to recommend IE prophylaxis for high-risk lesions, including mechanical valve (that is, 81% of hygienists and 91% of dentists recommending prophylaxis; P = .008).
CONCLUSIONS: There is 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. PRACTICAL IMPLICATIONS: Greater emphasis on IE prophylaxis education is required in training programs and continuing professional development.