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Myths of Dental-Induced Endocarditis

Michael J. Wahl, DDS
Arch Intern Med. 1994;154(2):137-144. doi:10.1001/archinte.1994.00420020037005.
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Although the latest (1990) American Heart Association recommendations for the prevention of bacterial endocarditis are by far the simplest yet, many physicians and dentists still do not comply with them. One of the reasons for this low compliance is that many clinicians rely on "myths" of dental-induced endocarditis prevention. To educate clinicians on endocarditis and its prevention, the myths of dental-induced endocarditis prevention are analyzed. Myth 1: For the most part, physicians and dentists are aware of and comply with American Heart Association guidelines on antibiotic prophylaxis for prevention of infective endocarditis. Myth 2: Most cases of bacterial endocarditis of oral origin are caused by dental procedures. Myth 3: American Heart Association antibiotic regimens give almost total protection against endocarditis after dental procedures. Myth 4: Antibiotics should be administered for any dental procedure that causes bleeding. Myth 5: If a patient was receiving recent antibiotic therapy before the dental procedure, there is no need to change the dose or the antibiotic before the dental procedure. Myth 6: The risk of endocarditis is almost always greater than the risk of antibiotic toxic effects. Myth 7: Parenteral antibiotics before dental procedures are preferable for most patients with high-risk conditions (eg, prosthetic heart valves and previous history of endocarditis). Myth 8: All patients with mitral valve prolapse should routinely receive antibiotic prophylaxis for dental procedures. Myth 9: Clinicians should err on the positive side of antibiotic prophylaxis to prevent lawsuits.

(Arch Intern Med. 1994;154:137-144)


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