Changing methods of preventing infective endocarditis following dental procedures: 1943 to 1993.

The report by Northrop and Crowley in the inaugural issue of the Journal of Oral Surgery heralded the appearance of studies designed to confirm both the relationship between dental procedure-induced bacteremia and infective endocarditis and the best methods to interrupt this chain of causation. Their discovery that antibiotics can modulate bacteremias produced by dental procedures eventually led to the universal adoption of the prophylactic regimens to prevent cases of infective endocarditis following dental procedures. Advances since their work have involved a greater understanding of the role of adherence in the mechanism of action of prophylactic antibiotics, an appreciation of the ability to limit antibiotic administration to only the immediate preoperative period, the need to keep prophylactic regimens as uncomplicated as is safe, and greater knowledge about the interaction between dental procedures and bacteremias. Whether the widespread use of prophylactic antibiotics during dental procedures significantly decreases the incidence of endocarditis remains open to future investigation.