Furthermore, there are numerous poorly documented case reports that implicate dental proce- dures associated with the development of IE, but these reports did not prove a direct causal relationship. Even in the event of a close temporal relationship between a dental procedure and IE, it is not possible to determine with certainty whether the bacteremia that caused IE originated from a dental procedure or from a randomly occurring bacteremia as a result of routine daily activities during the same time period. Many case reports and reviews have included cases with a remote preceding dental procedure, often 3 to 6 months before the diagnosis of IE. Studies suggest that the time frame between bacteremia and the onset of symptoms of IE is usually 7 to 14 days for viridans group streptococci or enterococci. Reportedly, 78% of such cases of IE occur within 7 days of bacteremia and 85% within 14 days.89 Although the upper time limit is not known, it is likely that many cases of IE with incubation periods longer than 2 weeks after a dental procedure were incorrectly attributed to the procedure. These and other factors have led to a heightened awareness among patients and healthcare providers of the possible association between dental procedures and IE, which likely has led to substantial overreporting of cases attributable to dental procedures. 