Infective endocarditis and oral health: a long-known threat, still a challenge

Infective endocarditis (IE) remains a life-threatening condition associated with high morbidity and mortality, often influenced by the complex interplay between systemic and oral health. The increasing recognition of oral health as a risk modifier has led to greater focus on the oral microbiome, dental procedures, and periodontal disease as potential contributors to bacteremia and IE. This review critically examines the relationship between oral health and IE, exploring pathophysiological mechanisms, risk factors, and the evolving epidemiology of the disease. The discussion includes diagnostic challenges, particularly in culture-negative cases, and the emerging role of advanced imaging and molecular diagnostics in improving early detection. A central focus is placed on preventive strategies, highlighting the debate surrounding antibiotic prophylaxis (AP) in high-risk individuals and the potential role of periodontal therapy in reducing systemic inflammation and transient bacteremia. The review also addresses the growing concern of antimicrobial resistance and the necessity of balancing AP recommendations with antimicrobial stewardship. Additionally, this review identifies critical research gaps, including the need for longitudinal studies on the impact of oral health interventions on IE incidence and the importance of interdisciplinary collaboration between dental and medical professionals in optimizing patient care. By synthesizing current guidelines and emerging evidence, this review underscores the necessity of an integrated, multidisciplinary approach to mitigate the burden of IE and establish oral health as a key pillar of infection prevention.