Peter Collignon, MB, BS
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Collignon P. Risk Factors for Infective Endocarditis. Ann Intern Med. 1999;131:154-155. doi: 10.7326/0003-4819-131-2-199907200-00018
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Published: Ann Intern Med. 1999;131(2):154-155.
TO THE EDITOR:
Strom and colleagues (1) concluded that dental treatment does not seem to be a risk factor for infective endocarditis even in patients with valve abnormalities. The main thrust of their paper is that antibiotics are overused. The reader is left with the impression that there is probably no place for antibiotic prophylaxis in this situation. I agree that their conclusions are valid for most dental treatments, but I think they have made a serious error in lumping all dental procedures together under the term “dental treatment.” Dental therapies of concern because they may lead to an increased risk for endocarditis are procedures associated with significant bleeding (that is, invasive dental procedures). Examples of these are tooth extraction, mouth and gingival surgery, and periodontal treatments. According to the data presented in the authors' Table 3, 18 case-patients had endocarditis associated with these procedures compared with 7 controls. This represents a 2.5 times greater occurrence of endocarditis. It is surprising that the authors did not highlight this, particularly because when they looked at tooth extraction alone, 6 case-patients and no controls had endocarditis. By their own calculations, this was a statistically significant difference (P = 0.03).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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