Odontologia e endocardite bacteriana: os procedimentos odontológicos são os verdadeiros vilões?

Abstract

Bacterial endocarditis (BE) is a serious systemic infectious disease that can be associated with the hematogenous spread of microorganisms, including those originating from the oral cavity. It occurs more frequently in individuals with predisposing conditions, such as structural heart disease, although it can also develop in patients without apparent comorbidities, particularly in the presence of periodontal disease. Invasive dental procedures, by disrupting tissue barriers, can facilitate the entry of bacteria into the bloodstream and trigger episodes of transient bacteremia, which are potentially involved in the disease's pathogenesis. This study aimed to evaluate the existence of a causal association between dental procedures and the development of infective endocarditis (IE), as well as to analyze the risk factors involved and the need for preventive measures, such as antibiotic prophylaxis. An integrative literature review was conducted using the SciELO, PubMed, and Google Scholar databases, covering articles published over the last 27 years. Initially, 1,047 studies were identified, of which 15 met the established inclusion criteria. The findings indicate that, although invasive dental procedures can induce bacteremia, their contribution to the development of bacterial endocarditis appears limited when compared to the cumulative bacteremia resulting from routine activities, such as daily oral hygiene. Despite studies estimating a probability of up to 19%, the presented confidence intervals do not rule out the possibility that this probability occurred by chance. Evidence also suggests that maintaining oral health plays a more significant role in disease prevention than isolated interventions. Antibiotic prophylaxis demonstrates benefits primarily in patients classified as high-risk; its indiscriminate use is not recommended due to potential adverse effects and the risk of bacterial resistance. Furthermore, the importance of continuing education for healthcare professionals is highlighted as a means to promote safe, evidence-based clinical practices.