ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis

“We've concluded that, if giving prophylactic antibiotics prior to a dental procedure works at all—and there's no evidence that it does work—we should reserve that preventive treatment only for those people who would have the worst outcomes if they get infective endocarditis. That's a profound change from previous recommendations.”

“The authors are to be congratulated. These recommendations do indeed represent a bold, dramatic, and welcome change from previous recommendations, and they will make many plaintiffs' attorneys unhappy. Many of us have pleaded for more rational guidelines over the years that recognize that only a small proportion of cases of endocarditis can be temporally (although not necessarily by cause and effect) related to dental procedures, and even fewer can be related to urological or gastrointestinal procedures.”

“Over the course of a year, the total number of minutes of exposure to bacteremia from twice-daily tooth brushing is some 154,000 times greater than from having a tooth pulled. Given that we don't recommend antibiotics in conjunction with tooth brushing, it makes no sense to recommend them for an infrequent event. Even if prophylaxis for a dental procedure were 100 percent effective, it would only prevent an exceedingly small number of cases.”