IDEA
Research type
Research Study
Full title
The Invasive Dentistry – Endocarditis Association (IDEA) Study: A Study of the link between invasive dental procedures and critical medical events including infective endocarditis, myocardial infarction, stroke, pulmonary embolus and spontaneous pre-term birth.
IRAS ID
221205
Contact name
Joanne Coster
Contact email
Sponsor organisation
University of Sheffield
Duration of Study in the UK
2 years, 2 months, 30 days
Research summary
Research Summary
There is concern that bacteria entering the circulation during invasive dental procedures (IDP) could precipitate critical medical conditions including infective endocarditis (IE), myocardial infarction (MI), stroke, pulmonary embolus (PE) and spontaneous pre-term-birth (SPTB).
Most concern has centred on IE, a heart infection with 30% first-year mortality where oral bacteria are the causal organism in 35-45% of cases. Indeed, before 2008 it was standard care for people at risk of IE to receive antibiotics before IDP. The effectiveness of doing this has never been proven, and in 2008 NICE recommended this should stop. However, the UK is the only country where antibiotics are not recommended for those at high-risk of IE and a recent study found that UK IE incidence has risen since 2008. The purpose of this study, therefore is to determine if there is a link between IDP and IE.
Much less is known about any causal link between IDP and MI, stroke, PE or SPTB. However, these are serious conditions with high mortality/morbidity and it is important that we know if IDP precipitates them or not.
We will use Hospital Episode Statistics data to identify patients who develop IE, MI, stroke, PE or SPTB and, using personally identifying details, link this to routinely collected dental data to identify those who had an IDP in the period preceding their medical event. Patient identifiable data will be processed and linked by NHS organisations. The research team will not receive patient identifiable data.
The study is important because If IE is linked to IDP there is potential to reduce the number of IE cases by using antibiotics. This could improve patient safety and reduce costs to the NHS. Identifying if IDP precipitates these other medical conditions is also important for patient safety and could allow preventative action to be taken
Summary of Results
The aim of the study was to link English national data on hospital admissions (from NHS Digital) and English national data on dental procedures (from the NHS Bussiness Services Authority (NHSBSA)) to determine if there is a link between invasive dental procedures and subsequent hospital admission with infective endocarditis (or other acute medical conditions including stroke, myocardial infarction, pulmonary embolism or pre-term birth). However, the study identified a failure in the way dental procedure data is collected in the period immediately before someone is admitted to hospital with an acute medical condition (or dies from an acute medical condition) that meant that it was impossible to accurately or reliably quantify any association between invasive dental procedures and the subsequent occurrence of these acute medical conditions. The study therefore failed to meet its original aims.
Following an amendment to our ethics approval, however, we were able to investigate any possible association between a list of invasive medical procedures and subsequent development of infective endocarditis. This was possible because the NHS Digital data we relied on to identify the timing and type of medical procedures performed in the period before a hospital admission for infective endocarditis was not affected by the same problem as the NHSBSA dental data.
This study identified a significant association between implantation of cardiac pacemakers/defibrillators, upper and lower gastrointestinal endoscopy, bronchoscopy, bone marrow biopsy, blood transfusion/red cell or plasma exchange and dental extractions performed in a hospital setting, and the subsequent development of infective endocarditis in individuals already at high risk for developing endocarditis.
REC name
South Central - Hampshire B Research Ethics Committee
REC reference
17/SC/0371
Date of REC Opinion
7 Aug 2017
REC opinion
Favourable Opinion