title: Dental Procedures and the Risk of Infective Endocarditis.
abstract: Infective endocarditis (IE) is an uncommon but potentially devastating disease. Recently published data have revealed a significant increase in the incidence of IE following the restriction on indications for antibiotic prophylaxis as recommended by the revised guidelines. This study aims to reexamine the basic assumption behind the rationale of prophylaxis that dental procedures increase the risk of IE.Using the Longitudinal Health Insurance Database of Taiwan, we retrospectively analyzed a total of 739 patients hospitalized for IE between 1999 and 2012. A case-crossover design was conducted to compare the odds of exposure to dental procedures within 3 months preceding hospitalization with that during matched control periods when no IE developed.In the unadjusted model, the odds ratio (OR) was 0.93 for tooth extraction (95% confidence interval [CI] 0.54-1.59), 1.64 for surgery (95% CI 0.61-4.42), 0.92 for dental scaling (95% CI 0.59-1.42), 1.69 for periodontal treatment (95% CI 0.88-3.21), and 1.29 for endodontic treatment (95% CI 0.72-2.31). The association between dental procedures and the risk of IE remained insignificant after adjustment for antibiotic use, indicating that dental procedures did not increase the risk of IE.Therefore, this result may argue against the conventional assumption on which the recommended prophylaxis for IE is based.
authors.affiliation: From the Clinical Informatics and Medical Statistics Research Center (PCC, CJC); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei (YCT, LSW, YSL, PHC); Department of Radiology, Chang Gung Memorial Hospital, Linkou (PWW); Department of Orthodontics and Craniofacial Dentistry, Division of Periodontology, Chang Gung Memorial Hospital, Taipei, Taiwan; and Cheers Dental Clinic, New Taipei, Taiwan (SK); Healthcare Center (PHC); and Heart Failure Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan (PHC).
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Chen
authors.forename: Ying-Chang
authors.initials: YC
authors.lastname: Tung
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Wu
authors.forename: Lung-Sheng
authors.initials: LS
authors.lastname: Wu
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lin
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Suefang
authors.initials: S
authors.lastname: Kung
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D015331:Cohort Studies; D003729:Dental Care / Q000009:adverse effects*; D012534:Dental Scaling / Q000009:adverse effects*; D004696:Endocarditis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment