Infective endocarditis, dentistry and antibiotic prophylaxis; time for a rethink?

Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required?

“…Prophylaxis against IE should primarily be concerned with the maintenance of good oral hygiene and prevention of oral disease to reduce the magnitude and frequency of spontaneous bacteraemia (Longman et al 1993). Because of the increasing evidence that spontaneous bacteraemia is more likely to cause IE than dental procedures (Seymour et al 2000), the importance of soft tissue health as a prophylactic measure for IE cannot be overstated (Lavelle 1996). Ethically, practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about antibiotic administration (Oliver et al 2004).…”

“…The relationship between dental procedures and IE has been supported by anecdotal clinical reports since 1908 (Robinson et al 1950, Durack 1985 and by animal experimental data (Bahn et al 1978). There is increasing evidence that spontaneous bacteraemia is more likely to cause IE in 'at-risk' patients than specific dental procedures (Seymour et al 2000). Two recent studies concluded that dental treatment was not a risk factor for IE (Lacassin et al 1995, Strom et al 1998.…”

“…Despite the use of AP in individuals at risk of IE undergoing invasive dental procedures the incidence of the disease has not altered (Durack 1994). Furthermore, this is against a background of a dramatic rise in the numbers of people receiving artificial heart valves (Seymour et al 2000).…”

Longitudinal comparison of Streptococcus mutans-induced aggravation of non-alcoholic steatohepatitis in mice

“…In that report, it was estimated that more than 1 × 10 4 CFU/mL bacteria are present in the bloodstream in approximately 60% of human subjects after invasive dental treatment, which is equivalent to more than 5 × 10 7 CFU in the entire body. In addition, random bacteraemia occurs after tooth brushing and flossing during daily life [28]. This information led us to consider that multiple administration of the bacteria should be evaluated in further studies.…”

Streptococcus mutans and cardiovascular diseases

“…Dissemination of oral bacteria into the bloodstream is known to be induced by professional dental treatment and daily oral care practices, such as tooth brushing and flossing, and even food chewing [49]. Also, serotype-specific RGPs were shown to contribute to the resistance to phagocytosis by human polymorphonuclear leukocytes [50].…”