Dentistry and endocarditis: beyond antibiotics

Kenneth A Hoekstra, PhD, Assistant Professor of Pathology,
February 07, 2007

Dear Editor,

In the report by Ashrafian1 and Bogle, the authors highlight new recommendations by the British Society for Antimicrobial Chemotherapy to limit prophylaxis to high-risk patients with previously documented endocarditis or surgical shunt/valve procedures (1). Although dental prophylaxis have an impact on systemic disease, they do not eliminate bacteremia altogether. Thus, in addition to antibiotic therapy, education and additional treatment modalities should also be available to prevent systemic conditions following dental procedures (2-3).

Reports indicate that regular postgraduate courses may be an effective avenue to educate practioners on appropriate antibiotic usage in patients with endocarditis. (4). As well, treatment options like stannous fluoride (5) and preventative care (6) may provide additional systemic protection to patients. Finally, a review of individual dental practices may also curb inappropriate antibiotic usuage (7).


1. Ashrafian H, Bogle RG.
Antimicrobial prophylaxis for endocarditis: emotion or science?
Heart 2007; 93: 5-6.

2. Ito HO.
Infective endocarditis and dental procedures: evidence, pathogenesis, and prevention.
J Med Invest. 2006; 53(3-4):189-98

3. Brincat M, Savarrio L, Saunders W.
Endodontics and infective endocarditis--is antimicrobial chemoprophylaxis required?
Int Endod J. 2006; 39(9):671-82.

4. Demirbas F, Gjermo PE, Preus HR.
Antibiotic prescribing practices among Norwegian dentists.
Acta Odontol Scand. 2006; 64(6):355-9.

5. Ramji N, Baig A, He T, Lawless MA, Saletta L, Suszcynsky-Meister E, Coggan J.
Sustained antibacterial actions of a new stabilized stannous fluoride dentifrice containing sodium hexametaphosphate.
Compend Contin Educ Dent. 2005; 26(9 Suppl 1):19-28.

6. Gottehrer NR, Berglund SE.
Antimicrobial host response therapy in periodontics: a modern way to manage disease.
Dent Today. 2006 Sep;25(9):84-7.

7. Chate RA, White S, Hale LR, Howat AP, Bottomley J, Barnet-Lamb J, Lindsay J, Davies TI, Heath JM.
The impact of clinical audit on antibiotic prescribing in general dental practice.
Br Dent J. 2006; 201(10):635-41.

Conflict of Interest

None declared