Invasive dental treatments including extractions and oral operations linked to infective endocarditis in high risk patients: Study Study

A new study published in the journal of Mayo Clinic Proceedings: Innovations, Quality & Outcomes showed that infective endocarditis (IE) was much more common in high-risk people following all invasive dental treatments, particularly extractions and oral operations.

Invasive dental operations have long been known to be a possible cause for infective endocarditis, which is still a significant hazard for people with underlying heart problems. Oral germs may enter the bloodstream as a result of these operations and stick to prosthetic or damaged heart valves. Preventive measures are essential because, despite the modest absolute risk, the effects might be dire.

Good dental hygiene, thorough risk assessment, and the judicious use of antibiotic prophylaxis in high-risk individuals are all important, according to recent research. Understanding how dental procedures contribute to transitory bacteremia helps doctors update recommendations and protect susceptible patients from this life-threatening illness.

Thus, this study measured the risk of infective endocarditis (IE) in individuals with cardiac risk factors that put them at low, moderate, or high risk of developing IE after several invasive dental operations. Using more than 16 months of data from May 1, 2007, to August 31, 2015, deidentified patient-level health data for all enrollees over the age of 18 with employer-provided commercial/Medicare-supplemental medical and dental coverage, or Medicaid benefits, were integrated using the linked IBM MarketScan administrative databases.

IE incidence in the 4 months after 53.6 million invasive dental surgeries was measured in the ensuing 9.6 million patient group. IE incidence in the 4 months after an IDP was 2195 IE cases/million operations in high-risk persons (e.g., prior IE, prosthetic/repaired heart valves, or cyanotic congenital heart disease), which is about 125 times greater than in low-risk individuals (OR 126.3; 95% CI, 113.5-140.6; P<.001).

After extractions (incidence 8680 IE cases/million extractions, OR 171.4; 95% CI, 136.7-214.8; P<.001) or other oral surgical operations (occurrence 13,458 IE cases/million procedures; OR 245.5; 95% CI, 165.1-365.1; P<.001), the IE-risk was significantly higher. Low-risk people had very little danger, whereas moderate-risk people had much reduced IE-risk.

Overall, the risk of adverse medication responses after antibiotic prophylaxis was much lower than the chance of IE in high-risk persons after all forms of IDP (especially after extractions and other oral surgical operations). Therefore, these results corroborate recommendations that high-risk persons undergo antibiotic prophylaxis and offer quantifiable information about the IE-risk that can be utilized to advise patients and secure their informed consent.

Source:

Thornhill, M. H., Lockhart, P. B., Dayer, M. J., Prendergast, B. D., & Baddour, L. M. (2025). Infective endocarditis risk after invasive dental procedures. Mayo Clinic Proceedings. Innovations, Quality & Outcomes, 9(6), 100676. https://doi.org/10.1016/j.mayocpiqo.2025.100676