The aetiology, epidemiology, pathogenesis and changing pattern of infective endocarditis, with a note on prophylaxis

Infective endocarditis remains a life-threatening condition, although the number of deaths due to this disease has fallen by 80% over the past 50 years. Dental undergraduate and postgraduate teaching rightly emphasises the use of prophylactic antibiotics for those patients most at risk of developing the condition. However, the types of patients at risk have also changed with the increased use of antibiotics and availability of heart surgery. While oral microorganisms may be incriminated in infective endocarditis, causal organisms arise from a number of other sites and in many cases the portal of entry is unknown. It is now thought that the proportion of cases that are apparently dentally related is probably smaller than previously believed. This article concentrates on the mechanisms by which this disease occurs, an area which is often poorly understood by undergraduates and postgraduates alike. An extract is included from the Lancet, which provides the most recent recommendations for endocarditis prophylaxis.