Coroner requires NICE to take

action following extraction-related

endocarditis death
Following an inquest in to the death of a 79-year-old Derbyshire
man, the assistant coroner for Derby and Derbyshire, Sophie
Lomas, has issued NICE with a Prevention of Future Deaths
Report. This legal document raises serious concerns on the part of
the coroner that require a response from NICE by 31 May 2024.
The patient in pain visited his dentist in November 2022 and
was found to need three teeth extracting. Because the patient had
a bio-prosthetic aortic valve and was taking anticoagulants, the
dentist advised the patient to discuss the safety of the procedure
Advertisement placeholder with his GP. The patient returned to the dentist on 26 November,
and indicated that the GP had no issues with him undergoing the
Hier steht eine Anzeige. procedure. The extractions were performed uneventfully, without
antibiotic prophylaxis cover, and the patient returned home to
Hier staat een advertentie. recuperate. On 30 November, the patient attended A&E with a
fever and a history of post-extraction bleeding. Because of the
history of a prosthetic heart valve and recent dental extractions,
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he was admitted for investigation and found to have positive
blood cultures. A trans-oesophageal echocardiogram confirmed
Hier steht eine Anzeige. a diagnosis of infective endocarditis, and he was treated with
antibiotics. Despite the treatment, he continued to deteriorate and
Hier staat een advertentie. sadly died in early January 2023.
The coroner has raised serious concerns about the fact NICE
Advertisement placeholder guideline CG64 states that ‘antibiotic prophylaxis against infective
endocarditis is not recommended routinely for people undergoing
dental procedures’ and provides no implementation advice for
Hier steht eine Anzeige.
dentists on how they should manage patients who are at an
increased risk of developing endocarditis.1
Hier staat een advertentie. The coroner pointed out that the Scottish Dental Clinical
Effectiveness Programme (SDCEP) provides advice for dentists on
Advertisement placeholder how to implement the NICE guidelines that include consideration
of antibiotic prophylaxis for patients at high-risk of infective
Hier steht eine Anzeige. endocarditis.2 Although the SDCEP advice is endorsed by NICE,
there is no mention of the SDCEP advice (or their endorsement of
it) in NICE guideline CG64 nor do the NICE guidelines include
Hier staat een advertentie. any implementation advice for dentists in England and Wales
on the use of antibiotic prophylaxis. The coroner also heard
evidence that because of their concerns about the NICE guidelines
cardiologists in England and Wales regularly follow the European
Society of Cardiology (ESC) guidelines, that conflict with the
NICE guidelines by recommending that all those at high-risk for
infective endocarditis should receive antibiotic prophylaxis before
undergoing invasive dental procedures.
The coroner requires NICE to respond to her concerns and take
action in order to prevent further deaths.

References
1. NICE. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against
infective endocarditis in adults and children undergoing interventional procedures:
overview. 2016. Available at: https://www.nice.org.uk/guidance/cg64 (accessed May
2024).
2. Scottish Dental Clinical Effectiveness Programme. Antibiotic Prophylaxis Against Infective
Endocarditis Implementation Advice. August 2018. Available at: https://www.sdcep.org.
uk/media/qvpj2kfb/sdcep-antibiotic-prophylaxis-implementation-advice.pdf (accessed
May 2024). ²

742 BRITISH DENTAL JOURNAL | VOLUME 236 NO. 10 | May 24 2024

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© British Dental Association 2024. © The Author(s) under exclusive licence to British Dental Association 2024.
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