journal article·2025-08-29Open access

Theoretical and Practical Knowledge Regarding Infective Endocarditis Prevention Among Dentists and Physicians: A Questionnaire-Based Survey

Claudia Salerno, Silvia Cirio, Nicole Camoni, Guglielmo Campus, Maria Grazia Cagetti

Applied Sciences· Volume 15· Issue 17

Abstract

Infective endocarditis (IE) is a rare but potentially life-threatening infection, often triggered by invasive procedures, dental or otherwise, in at-risk individuals. This study aimed to assess the knowledge of IE prophylaxis among healthcare professionals, focusing on dentists and physicians. Two validated, anonymous questionnaires were emailed to 27,000 healthcare providers in the province of Milan (Italy). A total of 970 responses were collected (response rate just over 3%), with 49.2% from physicians and 50.8% from dentists. No significant differences were found between the two groups regarding years of experience or guideline usage (p > 0.05), although more physicians (12.7%) than dentists (6.7%) reported unfamiliarity with any guidelines. Physicians often misclassified the risk associated with certain cardiac conditions and overprescribed prophylaxis for low-risk procedures, with overall accuracy falling below the expected performance benchmark (H0: 58.0% ± 2.0%). Dentists showed a better understanding of high-risk dental procedures, yet performance remained suboptimal, with multiple scores below the expected benchmark (H0: 68.0% ± 2.0%). These findings highlight widespread knowledge gaps and inconsistent adherence to IE prophylaxis guidelines. The results align with international observations and emphasize the urgent need for continuing education and improved dissemination of evidence-based recommendations across medical and dental settings.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Infective Endocarditis Diagnosis and Management · Streptococcal Infections and Treatments · Otolaryngology and Infectious Diseases

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy

Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland

Asst Valle Olona, Dental Unit, Via Eusebio Pastori 4, 21013 Gallarate, Italy

Department of Cariology, Institute of Odontology, Sahlgrenska Academin, University of Gothenburg, Medicinaregatan 12 E, 413 90 Gothenburg, Sweden

Department of Cariology, Saveetha Dental College and Hospitals (SIMATS), No. 162, Poonamallee High Road, Velappanchavadi, Chennai 600 077, India

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy

References (34)

Show source-provided references
1. Global, Regional, and National Burden and Quality of Care Index of Endocarditis: The Global Burden of Disease Study 1990-201910.1093/eurjpc/zwab211 ↗
2. Complex Infective Endocarditis: Uncommon Presentations and Their Multisystem Complications—A Case Series10.4103/jcecho.jcecho_77_24 ↗
3. Infective Endocarditis and Neurologic Events: Indications and Timing for Surgical Interventions10.1093/eurheartj/suaa167 ↗
4. Prevention of Infective Endocarditis: Guidelines from the American Heart Association10.14219/jada.archive.2008.0346 ↗
5. Guidelines on the Prevention, Diagnosis, and Treatment of Infective Endocarditis (New Version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC)10.1093/eurheartj/ehp285 ↗
6. Hollingshead, C.M., and Brizuela, M. (2025, August 27). Antibiotic Prophylaxis in Dental and Oral Surgery Practice, StatPearls [Internet], Available online: https://www.ncbi.nlm.nih.gov/books/NBK587360/.
7. Infective Endocarditis Following Invasive Dental Procedures: IDEA Case-Crossover Study10.3310/NEZW6709 ↗
8. Speroni, S., Polizzi, E., Giuffrè, M., Antonelli, L., Coccoluto, L., and Gherlone, E.F. (2024). Crestal Sinus Lift with the Hydrodynamic Technique: Prospective Clinical Study at 3 Years Follow-Up. Appl. Sci., 14.10.3390/app14146204 ↗
9. (2025, June 03). Prevention of Infective Endocarditis. Available online: https://Www.Heart.Org/-/Media/Files/Health-Topics/Infective-Endocarditis/Infective-Endocarditis-Wallet-Card.Pdf.
10. (2025, June 27). Antimicrobial Resistance. Available online: https://Www.Who.Int/News-Room/Fact-Sheets/Detail/Antimicrobial-Resistance?Utm_source=chatgpt.Com.
11. Alsergani, M., Zaini, R.H., Al Kholaif, N., Al Admawi, M., Savo, M.T., Cozac, D.A., Tansella, D., Aladani, B.A., Di Michele, S., and Pergola, V. (2025). Infective Endocarditis and Oral Health: A Long-Known Threat, Still a Challenge. Monaldi Arch. Chest Dis.10.4081/monaldi.2025.3497 ↗
12. Endocarditis Prophylaxis in Daily Practice of Pediatricians and Dentists in Flanders10.1007/s00431-020-03769-3 ↗
13. Is the CVI an Acceptable Indicator of Content Validity? Appraisal and Recommendations10.1002/nur.20199 ↗
14. Brandão, M.M., Latado, L., Oliveira, L.B., Sarmento, V.A., and Latado, A.L. (2023). Evaluation of Antibiotic Prophylaxis Prescriptions for Infectious Endocarditis Before Oral Procedures Between Cardiologists and Dentists. Int. J. Cardiovasc. Sci., 36.10.36660/ijcs.20230034 ↗
15. Rice, Z.S., and Liamputtong, P. (2023). Cultural Determinants of Health, Cross-Cultural Research and Global Public Health. Handbook of Social Sciences and Global Public Health, Springer International Publishing.10.1007/978-3-031-25110-8_44 ↗
16. Assessment of the Current Knowledge about Infective Endocarditis Prevention among Dental Hygienists in Italy: A National Survey10.1111/idh.12676 ↗
17. Sbricoli, L., Grisolia, G., Stellini, E., Bacci, C., Annunziata, M., and Bressan, E. (2024). Antibiotic-Prescribing Habits in Dentistry: A Questionnaire-Based Study. Antibiotics, 13.10.3390/antibiotics13020189 ↗
18. A Nationwide Survey of French Dentists’ Knowledge and Implementation of Current Guidelines for Antibiotic Prophylaxis of Infective Endocarditis in Patients with Predisposing Cardiac Conditions10.1016/j.oooo.2017.10.002 ↗
19. Current Knowledge among Japanese Experienced General Dentists Regarding Prevention of Infective Endocarditis10.1007/s10266-018-0344-7 ↗
20. Current Knowledge among Pediatric Dentistry Specialists in Japan Regarding Prevention of Infective Endocarditis10.1016/j.pdj.2018.01.001 ↗
21. Dentists’ Knowledge and Practice Regarding Prevention of Infective Endocarditis10.4103/1305-7456.195158 ↗
22. Antibiotic Prophylaxis for Infective Endocarditis: Knowledge and Implementation of American Heart Association Guidelines among Dentists and Dental Hygienists in Alberta, Canada10.1016/j.adaj.2015.03.021 ↗
23. Huang, G., Gupta, S., Davis, K.A., Barnes, E.W., Beekmann, S.E., Polgreen, P.M., and Peacock, J.E. (2020). Infective Endocarditis Guidelines: The Challenges of Adherence-A Survey of Infectious Diseases Clinicians. Open Forum Infect. Dis., 7.10.1093/ofid/ofaa342 ↗
24. Is Antibiotic Prophylaxis to Prevent Infective Endocarditis Worthwhile?10.1016/j.jiac.2017.10.006 ↗
25. Antibiotic Prophylaxis for Infective Endocarditis: A Systematic Review and Meta-Analysis10.1136/heartjnl-2015-309102 ↗
26. The Cost-Effectiveness of Antibiotic Prophylaxis for Patients at Risk of Infective Endocarditis10.1161/CIRCULATIONAHA.116.022047 ↗
27. Thornhill, M.H., Dayer, M.J., Forde, J.M., Corey, G.R., Chu, V.H., Couper, D.J., and Lockhart, P.B. (2011). Impact of the NICE Guideline Recommending Cessation of Antibiotic Prophylaxis for Prevention of Infective Endocarditis: Before and after Study. BMJ, 342.10.1136/bmj.d2392 ↗
28. Aragoneses, J.M., Aragoneses, J., Brugal, V.A., Algar, J., and Suarez, A. (2020). Evaluation of the Current Knowledge About Bacterial Endocarditis Prevention Among General Dentists in the City of Santo Domingo, Dominican Republic. Front. Public Health, 8.10.3389/fpubh.2020.585332 ↗
29. Antibiotic Prophylaxis of Infective Endocarditis in Oral and Maxillofacial Surgery: Incomplete Implementation of Guidelines in Everyday Clinical Practice10.1016/j.ijom.2019.09.007 ↗
30. Ahmadi-Motamayel, F., Fathi, S., and Roshanaei, G. (2024). Assessment of Endocarditis Prophylaxis Knowledge and Attitudes among Healthcare Practitioners in Tehran and Hamadan. BMC Oral. Health, 24.10.1186/s12903-024-04722-8 ↗
31. Giri, A.K., Chaudhary, M., Yadav, A.K., Shrestha, A., Bhagat, T., Agrawal, S.K., and Gautam, U. (2025). Knowledge and Perception of Antibiotic Prophylaxis for Dental Procedures among Nepali Dental Students: A Questionnaire-Based Study. BMC Oral. Health, 25.10.1186/s12903-025-06264-z ↗
32. Infective Endocarditis Antibiotic Prophylaxis: Review of the Evidence and Guidelines10.1007/s11886-023-02002-5 ↗
33. Is Italian Dentists’ Knowledge of Enamel Development Defects Adequate? A Nationwide Survey10.1016/j.identj.2024.04.013 ↗
34. Salerno, C., Conti, G., Cirio, S., Maspero, C., Senna, A., Campus, G., and Cagetti, M.G. (2025). Training Received, Knowledge, and Use of Silver Diamine Fluoride among Italian Dentists: A Nationwide Survey. BMC Oral. Health, 25.10.1186/s12903-024-05181-x ↗