Dental and Cardiac Risk Factors for Infective Endocarditis: A Population-Based, Case-Control Study

Abstract

Dental treatment does not seem to be a risk factor for infective endocarditis, even in patients with valvular abnormalities, but cardiac valvular abnormalities are strong risk factors. Few cases of infective endocarditis would be preventable with antibiotic prophylaxis, even with 100% effectiveness assumed. Current policies for prophylaxis should be reconsidered.

An infective endocarditis audit illustrates why dental guidelines in general need to be kept clear, simple and unambiguous

“…Infective endocarditis (IE) is an uncom mon but potentially fatal disease, and while antibiotic prophylaxis prior to some dental procedures was conventional in the United Kingdom (UK) until recently, the tenuous, if not over-emphasised link with dental treatment was beginning to be both scientifi cally challenged, [1][2][3] and acknowledged in civil law. 4 Nevertheless, throughout the history of IE prophylaxis, professional organisa tions have sought to identify and stratify the groups of patients considered to be at risk, as well as list those procedures for which antibiotic cover should be supplied, [5][6][7][8][9][10] although none of them have ever reached complete consensus with each other.…”

Intensity of bacteraemia associated with conservative dental procedures in children

“…A recent paper examined the relationship between the risk factors for endocarditis and showed that in a case control study that dental treatment was not a risk factor for infective endocarditis. 18 Whether it is yet time to abandon antibiotic prophylaxis for dental treatment or whether further evidence is required is a matter for the Endocarditis Working Party and similar advisory bodies at national and international level.…”

Update in Internal Medicine

“…Strom et al (104) conducted a population-based, case-control study of 273 patients with proven bacterial endocarditis and matched controls. They found no increase in the risk of bacterial endocarditis in patients with valvular abnormalities undergoing dental procedures.…”