We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Myths of Dental-Induced Endocarditis-Reply

Michael J. Wahl, DDS
Arch Intern Med. 1994;154(18):2114. doi:10.1001/archinte.1994.00420180123021.
Text Size: A A A
Published online


Moran is correct in that this case was almost certainly not caused by the dental procedure 10 weeks previous to symptoms. It is possible that the bacteremia causing the infection in this patient occurred while brushing with a mechanical toothbrush; but, it is also possible that the bacteremia occurred from eating a meal, chewing gum, or even "randomly." In the month before symptoms developed, this patient probably had 510 minutes of exposure to bacteremia from chewing and 4740 minutes of exposure from random bacteremias, but only 120 minutes from brushing.1 While the magnitude and intensity of brushing bacteremias may be greater than from random and chewing bacteremias, the time of exposure to bacteremia was, thus, over 40 times greater from random and chewing than from brushing.

Moran's letter brings up an interesting paradox: brushing and flossing can cause bacteremias in patients with gingival inflammation, but the best way to


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.