DENTIST'S ROLE IN THE PROPHYLACTIC MANAGEMENT OF INFECTIVE ENDOCARDITIS PRIOR TO TOOTH EXTRACTION: AN INTEGRATIVE REVIEW

Abstract

Infective endocarditis is a severe systemic infection with high mortality rates, frequently associated with transient bacteremia induced by invasive dental procedures, notably tooth extractions. This integrative review aimed to analyze the available scientific evidence regarding the efficacy of antibiotic prophylaxis prior to tooth extractions and the fundamental role of the dental surgeon in its preventive management. The literature reveals a historical lack of randomized clinical trials to prove or refute the efficacy of this practice, which is justified by logistical and ethical barriers considered insurmountable, forcing clinical guidelines to rely mostly on observational studies. Contemporary data demonstrate that, following dental procedures, there is a drastic change in the etiologic profile of the disease, with viridans group streptococci becoming the predominant causative pathogens in the majority of the analyzed cases. Although there are clear conceptual divergences among major global guidelines—ranging from restricted prescription to extremely vulnerable groups to the complete abandonment of pharmacological coverage in dentistry—recent meta-analyses indicate that the use of prophylaxis in individuals classified as high cardiac risk prevents the development of postoperative infections. On the other hand, empirical, routine, and indiscriminate prescription for patients without formal indication exposes the population to the risk of adverse drug reactions and actively contributes to the worsening of global antimicrobial resistance, in addition to lacking a favorable cost-effectiveness ratio. It is concluded that antibiotic prophylaxis is a valid and necessary therapeutic intervention, but it requires the dental surgeon to act in a non-dogmatic manner, strictly grounded in evidence-based practice, guiding decision-making through the correct stratification of each patient's systemic risk.