Antibiotic prevention of infective endocarditis due to oral procedures: myth, magic, or science?

Infective endocarditis (IE) can be induced by bacteremia attributable to dental procedures. To prevent this disease, prophylactic administration of antimicrobials prior to dental procedures has been recommended in several countries. However, no prospective study has proved its efficacy in a clinical setting. Recent recommendations from the American Heart Association (AHA) strongly suggested that dental work is not an important cause of IE; therefore, prophylactic use of antibiotics is of no use in most cases. Prevention of IE may be essential but its pathology and epidemiology remain unclear in various aspects. This article reviews the theoretical background of IE prophylaxis, and discusses how we should proceed when patients with a known cardiac disorder visit the dental clinic. The discussion includes antibiotics usage, daily maintenance procedures, and a possible new strategy with the use of antibacterial substances.