Is there a link between tooth brushing and infective endocarditis?

Tooth brushing is known to cause bacteraemias, which could theoretically potentially lead to the development of infective endocarditis. It is therefore paradoxical that tooth brushing is not thought to cause infective endocarditis. The reasons for this lack of association are not clear, but may be related to the fact that most oral procedures do not have a high association with infective endocarditis. There is no definitive data on the relative risks of using manual or electric toothbrushes in patients predisposed to infective endocarditis. It may be prudent to advise patients predisposed to infective endocarditis to use adjunctive chlorhexidine when cleaning their teeth with either a manual or electric toothbrush. The use of adjunctive chlorhexidine reduces the magnitude of any bacteraemia caused by tooth brushing and may interfere with the bacteria that could potentially cause infective endocarditis. Prophylactic antibiotics are not warranted for tooth brushing in patients at risk of infective endocarditis.