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

To provide a critical review of the current evidence that links dental treatment to infective endocarditis (IE) and appraise the risks of antibiotic chemoprophylaxis.

Retrospective analysis

Mainly hospital based patients or subjects

The interrelationship between infective endocarditis and dental treatment is complex and in many instances uncertain. The risk from antibiotic chemoprophylaxis appear greater than the risk of contracting IE.

There is increasing evidence that spontaneous bacteraemia are more likely to cause IE in at risk patients than specific episodes of dental treatment. Antibiotic chemoprophylaxis may not necessarily reduce dental-induced bacteraemia and the protective effect if any from antibiotic cover may arise from an inhibitory action upon bacterial colonisation on the compromised cardiac valves.

There is increasing concern over the misuse of antibiotics in general and this has focused attention on chemoprophylaxis in dentistry to prevent IE. New evidence on dental-induced bacteraemia and the prevalence of IE in association with dental treatment raises further questions on the need to provide antibiotic cover in at risk patients. More prescriptive guidelines to define who is at risk from IE and what procedures require cover will help to reduce overprescribing of antibiotics and reduce the risks of their unwanted effects.