Infective endocarditis risk following invasive dental procedures

Objective: To quantify the risk of infective endocarditis (IE) following different invasive dental procedures (IDPs) in patients with cardiac risk factors that place them at low-, moderate- or high-risk of developing IE. Patients and Methods: The linked IBM® MarketScan® administrative databases were used to integrate de-identified 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, through August 31, 2015. Results: In the resulting 9.6 million patient-cohort, IE-incidence in the four-months following 53.6 million IDPs 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 2,195 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 8,680 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. Conclusions: 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 (AP). Our data therefore support guidance recommending high-risk individuals receive AP and provide quantitative information concerning the IE risk that can be used to educate and obtain informed consent from patients.