Dentists are innocent! "Everyday" bacteremia is the real culprit: a review and assessment of the evidence that dental surgical procedures are a principal cause of bacterial endocarditis in children.

The literature related to three aspects of dental bacteremia has been reviewed in regard to postprocedure bleeding and bacteremia, intensity of bacteremia, and cumulative exposure to bacteremia from "everyday" events. The data on postprocedure bleeding and bacteremia show that there is no relationship between bleeding and bacteremia. Significant bacteremia can occur in the absence of clinically discernible bleeding. The intensity of bacteremia in humans is significantly less than that used in experimental endocarditis models. It is unlikely that the intensity of bacteremia following dental procedures in children could readily lead to endocarditis. The cumulative exposure to bacteremia is significantly greater from everyday procedures when compared to dental operative procedures. It is far more likely that such everyday procedures are the cause of bacterial endocarditis because the cumulative exposure is often hundreds, thousands, or even millions of times greater than that occurring following surgical procedures such as extraction of teeth. The value of antibiotic prophylaxis prior to dental treatment is questioned.