Sweden is one of the few countries that have removed the dental health recommendation of giving prophylactic antibiotics in people at a higher risk of infection of the heart valves, an infection called infective endocarditis. The recommendation was removed in 2012, and since then there has been no increase in the disease.
What is Infective Endocarditis?
Endocarditis is a life-threatening inflammation of the inner lining of the heart, the endocardium. It is usually caused by an infection by bacteria, fungi or other microorganisms from another part of the body, such as the mouth, spread through the bloodstream and attach to damaged areas of the heart.
Treatments for endocarditis include medications and, sometimes, surgery is required.
People at a higher risk of infective endocarditis typically receive prophylactic antibiotics, such as amoxicillin ahead of certain dental procedures, such as a tooth extraction or surgery. The recommendation was lifted in 2012 in Sweden due to lack of evidence that the treatment was necessary and to help prevent antibiotic resistance.
A study published in the journal Clinical Infectious Diseases, evaluated whether the incidence of oral streptococcal infective endocarditis increased among high-risk individuals after the cessation of antibiotic prophylaxis in Sweden after 2012.
The study included adult individuals (>17 years) living in Sweden from January 2008 to January 2018, with a diagnosis code or surgical procedure code indicating high risk of infective endocarditis. The registry study encompassed 76,762 high-risk individuals and 396,048 individuals at a low risk of infective endocarditis.
The study found no increased incidence of oral streptococcal infective endocarditis among high-risk individuals during the five years after the cessation, compared to before.
After the change in recommendation in 2012, prescriptions for amoxicillin in dentistry declined by approximately 40%. However, the study can’t demonstrate that this was an effect of the amended recommendation and amoxicillin has other uses in dental medicine.
Emily Henderson, B. Sc. (2022, Feb 17). Cessation of antibiotic prophylaxis in dentistry led to no increase in infective endocarditis. News Medical Life Sciences. Retrieved from:
Vähäsarja, N., et al. (2022) Infective endocarditis among high-risk individuals – before and after the cessation of antibiotic prophylaxis in dentistry: a national cohort study. Clinical Infectious Diseases. doi.org/10.1093/cid/ciac095.