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ORAL MICROFLORA AS A CAUSE OF ENDOCARDITIS AND OTHER DISTANT SITE INFECTIONS

1999; Elsevier BV; Volume: 13; Issue: 4 Linguagem: Inglês

10.1016/s0891-5520(05)70111-2

1557-9824

Peter B. Lockhart, David T. Durack,

Streptococcal Infections and Treatments

Bacteremia originating from the oral cavity is common and sometimes causes infections at distant sites, such as infective endocarditis (IE); however, there are many unresolved questions concerning the role of the oral cavity in the causation of IE and other distant site infections (DSI). The literature is extensive but consists primarily of retrospective data and case reports that lack adequate historical and demographic data or information on the extent of odontogenic disease and the invasiveness of any associated dental procedures. Furthermore, because normal daily activities, such as chewing food, brushing, and flossing, frequently cause bacteremia, these case studies fail to prove a causal relationship between dental procedures and DSI.89, 152 Most, if not all, invasive dental procedures can cause bacteremia. This is of little consequence for healthy individuals with intact immune systems, but could harm individuals who are more susceptible to bacterial colonization and invasion by reason of anatomical abnormalities or immunosuppression.130 The numerous case reports, articles, and animal studies published on this issue have given rise to assumptions and controversies concerning the risks of dental procedures in people believed to be at risk. Clinical practice guidelines for antibiotic prophylaxis were established over 40 years ago for certain cardiac conditions, and since then they have been extended to other patient populations1, 2; however, these guidelines are not firmly evidence based. The result is a questionable standard of care that emphasizes administration of antibiotics before dental procedures rather than good oral hygiene and optimal oral disease management. The importance of dental procedures as a cause of IE and the use of antibiotic prophylaxis to prevent it have been controversial issues for many years.* A number of assumptions and misconceptions have evolved concerning the risks from dental procedures and the identification and management of this population. Given the confusion concerning a standard of care for people potentially at risk for DSI, clinicians should understand the issues affecting indications and timing for prophylactic antibiotics.