Dental procedures and associated risk of infective endocarditis

Dental procedures may cause bacteremia, which is considered a risk factor for infective endocarditis (IE). This study sets out to examine whether dental procedures are associated with an increased risk of IE.

We examined the nationwide time-dependent association between dental procedures and risk of bacteremia and IE among Danes > 18 years on January 1, 2010. Adjusted hazard ratios (HR) for bacteremia and IE were estimated by Cox regression with time-varying exposure (dental visit and three months later).

We examined 4,178,514 persons who had dental care (66.9% of residents, median age 44 years [IQR 30-49]). During 9 years of follow-up, 69,928 (1.7%) persons had bacteremia, and 3,754 (0.09%) had IE. Among those with bacteremia or IE in the proximity of dental care (within three months), Streptococci accounted for 16.1% and 26.9%, respectively. The adjusted HRs for bacteremia and IE associated with dental procedures were 0.94 (95% CI 0.92-0.95) and 1.00 (95% CI 0.94-1.08), respectively, compared with non-exposed time. No dose-response relationship for invasive vs non-invasive procedures was found. The IE risk associated with dental care was not different in high-risk patients (prior IE, valve prostheses, or congenital heart disease): HR 0.96 (95% CI 0.83-1.10).

We did not find an association between dental procedures and bacteremia or IE, and this was irrespective of high-risk cardiac preconditions.