How important are dental procedures as a cause of infective endocarditis

摘要: Eighteen pediatric patients with infective endocarditis (IE) were reviewed for "failure" of chemoprophylaxis; none had a previous dental procedure. Surprisingly, published reports reveal similarly low prevalence extractions preceding IE, only 3.6% 1,322 cases. Although bacteremia was associated 40% 2,403 reported extractions, it also found in 38% after mastication, and 11% oral sepsis no intervention. In hypothetical month, ending single extraction, the cumulative exposure to these "physiologic" sources is nearly 1,000 times greater than from extraction. The current American Heart Association recommendations intramuscular or intravenous chemoprophylaxis are impractical, discomfort inconvenience may impede good care. Committee implies that gingival bleeding allows bacterial access blood stream, whereas experimental studies establish lymphatics as access. major procedures appears prudent, British regimen dose amoxicillin administered orally much simpler probably more effective. However, scrupulous hygiene undoubtedly superior preventing IE any regimen.