Dental Procedures and the Risk of Infective Endocarditis
Dental Procedures and the Risk of Infective Endocarditis
复制标题
DOI：
10.1097/md.0000000000001826
复制
发表时间：
2015-10-01
期刊：
影响因子：
1.6
通讯作者：
Chu, Pao-Hsien
中科院分区：
文献类型：
--
作者：
Chen, Pei-Chun;Tung, Ying-Chang;Chu, Pao-Hsien
感染性心内膜炎（IE）是一种罕见的，但潜在的破坏性疾病。最近发表的数据显示，在修订后的指南建议限制抗生素预防适应症后，IE的发病率显著增加。本研究的目的是重新检查背后的基本假设，预防的理由，牙科手术增加IE的风险。使用纵向健康保险数据库的台湾，我们回顾性分析了1999年至2012年期间，共739例IE住院患者。采用病例交叉设计，比较住院前3个月内与对照期间（未发生IE）暴露于牙科手术的比值比，在未校正模型中，拔牙的比值比（OR）为0.93（95%置信区间[CI] 0.54-1.59），手术为1.64（95% CI 0.61-4.42），洁牙为0.92（95% CI 0.59-1.42），牙周治疗1.69（95% CI 0.88-3.21），牙髓治疗1.29（95% CI 0.72-2.31）。在调整抗生素使用后，牙科手术与IE风险之间的关联仍然不显著，表明牙科手术并没有增加IE的风险。因此，这一结果可能与推荐的IE预防措施所依据的传统假设相矛盾。
Infective endocarditis (IE) is an uncommon but potentially devastating disease. Recently published data have revealed a significant increase in the incidence of IE following the restriction on indications for antibiotic prophylaxis as recommended by the revised guidelines. This study aims to reexamine the basic assumption behind the rationale of prophylaxis that dental procedures increase the risk of IE.Using the Longitudinal Health Insurance Database of Taiwan, we retrospectively analyzed a total of 739 patients hospitalized for IE between 1999 and 2012. A case-crossover design was conducted to compare the odds of exposure to dental procedures within 3 months preceding hospitalization with that during matched control periods when no IE developed.In the unadjusted model, the odds ratio (OR) was 0.93 for tooth extraction (95% confidence interval [CI] 0.54-1.59), 1.64 for surgery (95% CI 0.61-4.42), 0.92 for dental scaling (95% CI 0.59-1.42), 1.69 for periodontal treatment (95% CI 0.88-3.21), and 1.29 for endodontic treatment (95% CI 0.72-2.31). The association between dental procedures and the risk of IE remained insignificant after adjustment for antibiotic use, indicating that dental procedures did not increase the risk of IE.Therefore, this result may argue against the conventional assumption on which the recommended prophylaxis for IE is based.