Risk of Infective Endocarditis Following Invasive Dental Procedures in Patients With Congenital Heart Disease

Invasive dental procedures (IDPs) may trigger infective endocarditis (IE) in patients with congenital heart disease (CHD). However, data quantifying this risk remain limited. This study aimed to investigate the association between IDPs and the risk of IE in CHD. We conducted a nationwide, self-controlled case series study using Taiwan's National Health Insurance Research Database (2009-2019). The overall risk period was defined as 0-4 months following an IDP, further divided into four consecutive monthly risk periods. Incidence rate ratios (IRRs) were estimated via conditional Poisson regression. Among 132,123 CHD patients, 633 who experienced hospitalization for IE were analyzed. The adjusted IRR for IE was 2.27 (95% CI, 1.93-2.68) during the overall risk period following an IDP. The risk was highest in the first month post-IDP (IRR 3.03; 95% CI, 2.40-3.82), then declined over the second (IRR 1.91; 95% CI, 1.45-2.52), third (IRR 1.63; 95% CI, 1.21-2.20), and fourth months (IRR 1.32; 95% CI, 0.95-1.84). Elevated first-month IE risk was observed in both severe (IRR 4.01, 95% CI, 1.53-10.52) and simple CHD (IRR 2.98, 95% CI, 2.35-3.79). Similar risk patterns were observed across all subgroups, irrespective of CHD severity, sex, age, or comorbidities. This nationwide study provides new evidence of an increased risk of IE following IDPs in patients with CHD, with the risk persisting for up to 3 months. These findings highlight the need for increased clinical awareness and monitoring of IE in CHD patients undergoing IDPs.