The authors concluded that dental treatment was not a risk factor for IE even in patients with valvular heart disease and that few cases of IE could be prevented with prophylaxis even if it were 100% effective. These studies are in agreement with a recently published French study of the estimated risk of IE in adults with predis- posing cardiac conditions who underwent dental procedures with or without antibiotic prophylaxis.88 These authors con- cluded that a huge number of prophylaxis doses would be necessary to prevent a very low number of IE cases. Absolute Risk of IE Resulting From a Dental Procedure No published data accurately determine the absolute risk of IE that results from a dental procedure. One study reported that 10% to 20% of patients with IE caused by oral flora underwent a preceding dental procedure (within 30 or 180 days of onset).85 The evidence linking bacteremia associated with a dental procedure with IE is largely circumstantial, and the number of cases related to a dental procedure is overes- timated for a number of reasons. For 60 years, noted opinion leaders in medicine suggested a link between bacteremia- causing dental procedures and IE,23 and for 50 years, the AHA published regularly updated guidelines that emphasized the association between dental procedures and IE and recom- mended antibiotic prophylaxis.1 Additionally, bacteremia- producing dental procedures are common; it is estimated that at least 50% of the population in the United States visits a dentist at least once a year. 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. 