The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the Editor

Editor, – It was with great interest that I read the 'Diagnostic tests: Echocardiography' article (Aust Prescr 2006;29:134-8), particularly in relation to the ability of this test to differentiate between valvular disease and benign flow murmurs.1 However, I was surprised that there was no 'Dental note' highlighting the importance of echocardiography in the assessment of patients requiring antibiotic prophylaxis for dental treatment.

A study found that 370 patients out of 20 000 indicated in their medical history that they had a heart murmur or had had rheumatic fever and that they usually received antibiotic prophylaxis for dental treatment.1 After evaluation of their murmur by electrocardiography and Doppler flow ultrasonography, only 50 had a defect that met current indications for antibiotic prophylaxis for infective endocarditis.2 Furthermore, the risk of an adverse reaction to the antibiotics and the selection of antibiotic resistant bacterial strains in these patients needs to be considered.

Dental patients reporting an indefinite history of rheumatic fever or cardiac murmur should be referred to their general practitioner, or directly to a cardiologist for diagnosis by echocardiography. This should determine whether or not they require antibiotic prophylaxis for infective endocarditis, in accordance with current guidelines.

Ray Heffer
Endodontic Registrar
Oral Health Centre of Western Australia
School of Dentistry, The University of Western Australia


  1. Ching M, Straznicky I, Goss AN. Cardiac murmurs: echocardiography in the assessment of patients requiring antibiotic prophylaxis for dental treatment. Aust Dent J 2005;50(4 Suppl 2):S69-73.
  2. Singh J, Straznicky I, Avent M, Goss AN. Antibiotic prophylaxis for endocarditis: time to reconsider [review]. Aust Dent J 2005;50(4 Suppl 2):S60-8.