Infective endocarditis and dentistry: the legal basis for an association.
OBJECTIVE
The objectives of this study were to determine on what evidence infective endocarditis (IE) could be legally linked to dental treatment.


METHODS
The records of 319 legal cases involving dental treatment as the probable cause of IE were analysed. The medical history, type of dental operation, and whether antibiotic prophylaxis was provided were noted. The time taken for the onset of symptoms (incubation period) and hospitalisation was calculated. The identity of the infecting micro-organism was investigated and it was also noted whether litigation was successful for the patient.


RESULTS
A total of 83 patients were successful in legally linking dental treatment to the onset of infective endocarditis. In all successful cases there was a short incubation period (circa nine days) and in 80 of the patients an oral Streptococcus was isolated. The dental operations included exodontia (28), scaling (29), endodontics (12) and minor oral surgery (11).


CONCLUSIONS
Dental treatment was deemed to be the probable cause of IE in 26% of patients who sought litigation. In the majority of legal cases clinicians did not follow recognised guidelines or keep adequate clinical notes. The three main factors which link dental procedures legally were the dental operation, the isolation from the blood of an oral micro-organism and a short incubation period.
Martin
M V
MV
Oral Microbiology, Department of Clinical Dental Sciences, University of Liverpool, Liverpool, UK. m.v.martin@btinternet.com
Longman
L P
LP
Forde
M P
MP
Butterworth
M L
ML
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D003729:Dental Care / Q000009:adverse effects*; D017742:Dental Care for Chronically Ill / Q000331:legislation & jurisprudence* / Q000592:standards*; D003792:Dental Records / Q000331:legislation & jurisprudence; D004697:Endocarditis, Bacterial / Q000209:etiology*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007603:Jurisprudence; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D012189:Retrospective Studies; D013298:Streptococcus sanguis / Q000302:isolation & purification