08 September 2023

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How well do dental hygienists understand infective endocarditis prevention?

Lara Figini

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Infective endocarditis (IE) is a rare infection of the endocardium and heart valves, with a mortality rate that is high. Over the years, this has led to the development of specific guidelines with the indication of performing preventive antibiotic prophylaxis in subjects destined for certain procedures considered at risk. Among these, there are also numerous dental treatments.

To date, there is a lack of data relating to the knowledge and correct application of the guidelines issued in 2015 by the European Society of Cardiology (ESC) for the prevention of infective endocarditis among dentists in Italy. Similarly, there are no data on the understanding and adherence to them by dental hygienists.

Researchers aimed to evaluate the ability of hygienists to recognize and manage categories of patients at high risk of IE, to identify which dental procedures are most at risk and to know the active ingredients, doses and methods of administration of antibiotic prophylaxis. The team developed a questionnaire consisting of 12 questions and divided into two sections, "personal data" and "degree of knowledge of the EI Guidelines." This survey was administered to dental hygienists, making it accessible anonymously online and sharing a link using Google Forms.

Personal data and information on the educational background were thus collected to obtain a profile of the participants which was then collected in a study published in the International Journal of Dental Hygiene in March 2023.

In total, 362 dental hygienists responded to the web survey, with demographics revealing a strong female prevalence (86.7%). The most represented age group was that of 30-39 years (43.1%).

No statistically significant differences were found regarding the overall number of incorrect questions when considering gender differences, different ages of participants and year of graduation.

Graduates from northern Italy made fewer mistakes than graduates from other geographic areas. 

The highest percentages of errors occurred on the choice of antibiotic prophylaxis dosage (43% of incorrect answers) and on the need for prophylaxis on patients with coronary syndrome who underwent the application of a stent or coronary bypass (51% of wrong answers).

Researchers said that this was the largest survey about the knowledge of IE for dental hygienists ever performed. Because the overprescription of antibiotics contributes to the development of drug resistance, antibiotic stewardship should be at the forefront of patient care. The data reflect the need for placing a greater emphasis on IE prophylaxis education in training and during continuing professional development events for dental hygienists.

Mario Carbone et al." Assessment of the current knowledge about infective endocarditis prevention among dental hygienists in Italy: A national survey." International Journal of Dental Hygiene. 23 March 2023. https://doi.org/10.1111/idh.1267