'I went to have my tooth taken out and I almost died from an infection'

A Welsh man who almost died having a tooth taken out wants a change to medical guidance. Greg Hutton, 62, survived two severe bouts of endocarditis, a serious and often deadly heart infection, which has a 30% fatality rate for sufferers within a year.

The infection occurred after he had a tooth removed without being administered pre-emptive antibiotics, despite having a heart condition that increases his susceptibility to infections. Mr Hutton, who is from Swansea, is adamant that if he had received antibiotics before the dental procedure, he might have evaded the infection and a subsequent heart attack.

His initial bout with endocarditis happened post-tooth extraction in November 2017, when his dentist declined to prescribe pre-operation antibiotics. The dentist said he was following the National Institute for Health and Care Excellence (Nice) guidelines, which guide NHS practices.

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Although Nice has updated their guidance this year with a a link to Scottish dental information, Mr Hutton doesn't think this goes far enough. For the latest health and Covid news, sign up to our newsletter here

Speaking to the PA news agency, he said: "It was horrendous, absolutely horrendous, not just for me but for my family as well, for my wife especially.

"Before all this happened in 2017 I used to run, I was quite fit, I used to play five-a-side football in work, then to have that suddenly taken away. It’s always been something of mine to keep fit and maintain my fitness for as long as possible. Without that, I would be dead."

Mr Hutton was born with a bicuspid valve, a congenital heart defect where the aortic valve has two flaps instead of the normal three, for which he had a replacement in 2014. Recalling his dentist appointments, he said: "In 2017 I had a problem with one of my fillings, I went to see the dentist and he said, ‘we’re going to have to pull the tooth’.

"Come the day of the appointment I went to see him, and he said he couldn’t give me antibiotics because it goes against the Nice guidelines, and he would get into trouble. I would be considered a high-risk patient anywhere else in the world because of my heart valve operation, but in 2008 Nice changed the guidelines because there had been a scare about too many antibiotics prescribed.

"The dentist, who had had several months to check out what was the best treatment for me prior to extracting the tooth, basically said, ‘I’m going to pull the tooth, but you can’t have antibiotics’."

Two weeks after his tooth was removed, Mr Hutton began to feel very unwell and struggled with basic mobility. Despite numerous medical consultations, his condition remained a mystery for some time. He had 35 appointments to try to identify the issue.

"My GP thought it was leukaemia at one point, but nothing was showing in the blood test," he added. "My organs were failing, and it felt like they were taking it in turns to give me a kicking from the inside."

"They were breaking down slowly, kidney problems, liver problems, I was struggling to breathe."

It was only when Mr Hutton began searching for the cause of his enlarged spleen that he learned a tooth extraction can sometimes lead to endocarditis. He said: "I went into the hospital and didn’t come out for four months, I was in a hell of a state."

The sole treatment effective against the infection was gentamicin, which made Mr Hutton go deaf in one ear, and he also suffered an embolism in his spleen. However, just a few months into his recovery, he fell ill once more.

He explained: "I went to my GP, he looked at me and he said, ‘you’re going straight to hospital’. I said I’d go pack a bag, he said ‘no, I’m taking you straight to hospital’."

"He sat me in his car and drove me straight there and I spent another three months in hospital." During his second hospital stay, he was treated for fungal endocarditis, which can be more deadly than the bacterial infection he had previously suffered.

"According to statistics I should be dead, I put that down to my fitness," he stated. "After three months, I was discharged with the words, ‘go home, enjoy the rest of your life, or however long that may be’."

"They felt, I’m sure, that I might have a couple of years to survive because the mortality rate is very high. Then a couple of months later, I was in the garden and I had a heart attack."

He estimated that the NHS has spent approximately £400,000 to keep him alive, whereas a sachet of antibiotics would have cost just a few pounds. After being discharged, Mr Hutton sought legal advice from Wolferstans Solicitors and received a substantial settlement from his dentist, which he believes is one of the largest on record.

He has now written to NICE, urging them to change their guidelines. Although NICE began referencing Scottish dental information in its guidance this year, Mr Hutton feels this does not go far enough.

He is concerned that dentists in Wales and England will continue to assume the information is only relevant for Scotland and insists that new, clear guidance is necessary.

Holly Bowditch of Wolferstans Solicitors said: "Since the Nice guidelines were changed in 2008, advising against the prescription of antibiotics prior to an invasive dental procedure, around 6,700 people have contracted endocarditis when it could have been avoided."

"It is estimated that around 2,000 deaths have occurred which could have been prevented." She criticised the current guidance as "ambiguous" and stressed the need for clarity.

She concluded: "If more specific guidance was available, it could prevent harm to many individuals, but would also offer dentists much-needed clarity on what to do when presented with a high-risk patient."

A Nice spokesman said they had published an update to their guidance in October and while advice remains antibiotics should not be prescribed routinely to prevent infective endocarditis (IE) it “may be appropriate” for certain people with structural heart defects.

He said the Nice recommendations directly link to advice from the Scottish Dental Clinical Effectiveness Programme. "This advice on antibiotic prophylaxis for people at high risk of infective endocarditis undergoing dental procedures and relevant patient information was developed in conjunction with, and is endorsed by, Nice.”

He added: “While there is some new evidence about the benefits of preventive use of antibiotics for people at higher risk of IE, this remains insufficient to change the overall recommendations in the Nice guideline, which seeks to balance the potential benefits of antibiotics with the risks of increasing anaphylaxis and antibiotic resistance.”