Given the preponderance of published data, there may not be a clinically significant difference in the frequency, nature, magnitude, and duration of bacteremia associated with a dental procedure compared with that resulting from routine daily activities. Accordingly, it is inconsistent to recommend prophylaxis of IE for dental procedures but not for these same patients during routine daily activities. Such a recommenda- tion for prophylaxis for routine daily activities would be impractical and unwarranted. Impact of Dental Disease, Oral Hygiene, and Type of Dental Procedure on Bacteremia It is assumed that a relationship exists between poor oral hygiene, the extent of dental and periodontal disease, the type of dental procedure, and the frequency, nature, magnitude, and duration of bacteremia, but the presumed relationship is controversial.23,29,30,38,45,54 61 Nevertheless, available evi- dence supports an emphasis on maintaining good oral hy- giene and eradicating dental disease to decrease the frequency of bacteremia from routine daily activities.45,56 58,62,63 In patients with poor oral hygiene, the frequency of positive blood cultures just before dental extraction may be similar to that after extraction.62,63 More than 80 years ago, it was suggested that poor oral hygiene and dental disease were more important as a cause of IE than were dental procedures.64 Most studies since that time have focused instead on the risks of bacteremia associated with dental procedures. For example, tooth extraction is thought to be the dental procedure most likely to cause bacteremia, with an incidence ranging from 10% to 100%.* However, numerous other dental procedures have been re- ported to be associated with risks of bacteremia that are similar to that resulting from tooth extraction. 