CHALLENGING THE customary practice of the last quarter-century, "Myths of Dental-Induced Endocarditis"1 by dental surgeon Michael J. Wahl, DDS, becomes especially interesting and informative. It reasonably demands that we all reconsider the comfortable recommendations of the American Heart Association (AHA) for the prevention of bacterial endocarditis, revised appropriately and periodically since first issued in 1965. Further reflection will also bring certain operations on the intestinal and respiratory mucosa (bronchoscopy, esophageal dilation, gallbladder surgery), urologic surgery, gynecologic instrumentation, and general surgery under consideration.
The evolving microbial spectrum of bacterial endocarditis dictates substantial new management and prophylaxis for endocarditis today. Ever since 1893, William Osler's "endocarditis lenta" has continued to fascinate clinicopathologic conferences. It occurs (rarely) in 1.7 to four per 100 000 person-years in population and supplies attorneys with substantial rewards from litigation. Guidelines for prophylaxis and treatment are eagerly sought, not only for application in clinical medicine but also