Infective Endocarditis Risk After Invasive Dental Procedures

TL;DR

This study finds that high-risk patients have a significantly increased risk of infective endocarditis after invasive dental procedures, especially extractions and oral surgeries.

Contribution

The study quantifies IE risk following dental procedures for different cardiac risk groups using a large patient cohort.

Findings

High-risk individuals had 125 times higher IE incidence after dental procedures compared to low-risk individuals.

Extractions and oral surgeries showed the highest IE risk in high-risk patients.

The risk of IE in high-risk patients far exceeds the risk of adverse drug reactions from antibiotic prophylaxis.

Abstract

To quantify the risk of infective endocarditis (IE) following different invasive dental procedures in patients with cardiac risk factors that place them at low-risk, moderate-risk, or high-risk of developing IE.

The linked IBM MarketScan administrative databases were used to integrate deidentified patient-level health data for all enrollees over 18 years of age with employer-provided commercial/Medicare-supplemental medical and dental coverage, or Medicaid benefits, with more than 16 months of data from May 1, 2007, to August 31, 2015.

In the resulting 9.6 million patient cohort, IE incidence in the 4-months following 53.6 million invasive dental procedures was quantified. In high-risk individuals (e.g. previous IE, prosthetic/repaired heart valves, or cyanotic congenital heart disease), IE incidence in the 4 months following an IDP was 2195 IE cases/million procedures - ∼125 times higher than in low-risk (OR 126.3; 95% CI, 113.5-140.6; P<.001). The IE-risk was even greater following extractions (incidence 8680 IE cases/million extractions, OR 171.4; 95% CI, 136.7-214.8; P<.001) or other oral surgical procedures (incidence 13,458 IE cases/million procedures; OR 245.5; 95% CI, 165.1-365.1; P<.001). Moderate-risk individuals were at significantly lower IE-risk, and low-risk individuals were at negligible risk.

The risk of IE was high in high-risk individuals following all types of IDP (particularly following extractions and other oral surgical procedures) and vastly exceeded the risk of adverse drug reactions following antibiotic prophylaxis. Our data therefore support guidance recommending high-risk individuals receive antibiotic prophylaxis and provide quantitative information concerning the IE-risk that can be used to educate and obtain informed consent from patients.

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