The possibility that bacteremia from the mouth could cause infective endocarditis (IE) was first suggested over a hundred years ago, and it was later reinforced by others who targeted the viridans group streptococcus (VGS) from poor oral hygiene and dental extractions.(1-3) These observations, along with the advent of antibiotics, eventually led to the first guidelines from the American Heart Association (AHA) in 1955. Antibiotic prophylaxis (AP) became the primary focus for prevention of IE, and a standard of care for countries around the world. Controversy concerning efficacy and safety issues has existed for over 30 yeas and there has been a progressive reduction in the patient populations and the procedures suggested for AP since that time. Of concern, and in spite of a decreasing emphasis on AP for cardiac patients, upwards of 25 non-cardiac patient populations are recommended for AP by some clinicians out of concern for systemic infections that might originate from dental procedures (e.g., prosthetic joints).(4) (SELECT FULL TEXT TO CONTINUE).
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