Applying Pascal’s Wager to Antibiotic Prophylaxis Decision for Patients with Infective Endocarditis Undergoing Dental Implant Surgery



Teleconsultation – 2023-07-18 12:57

I have infective endocarditis. It is planned that I get an implant. Is prescribing antibiotic prophylaxis a good idea? Apply Pascal´s wager to make a decision about antibiotic prophylaxis.

When considering the question of whether to prescribe antibiotic prophylaxis for a dental implant procedure in a patient with infective endocarditis, it can be helpful to apply Pascal’s wager. Pascal’s wager is a philosophical argument that suggests it’s more beneficial to believe in something and be wrong, than not believe in it and be wrong. In this case, the “belief” is that antibiotic prophylaxis is beneficial.

Here’s how the wager might look:

Antibiotic Prophylaxis True Antibiotic Prophylaxis False
Believe Antibiotic Prophylaxis Works Gain all (prevent infective endocarditis) Waste resources (unneeded antibiotics, possible side effects)
Do Not Believe Antibiotic Prophylaxis Works Lose all (risk of infective endocarditis) Gain nothing (saved resources, but risked health)

In the context of this wager, the safest bet would be to prescribe antibiotic prophylaxis. If you do, and it’s necessary, you prevent a serious health issue. If you do, and it’s not necessary, you’ve wasted some resources and potentially caused side effects, but these are generally minor compared to the risk of developing infective endocarditis. If you don’t prescribe antibiotics and they’re necessary, you risk serious health consequences. If you don’t prescribe, and they’re not necessary, you’ve saved some resources, but the potential downside far outweighs this benefit.

Therefore, given the potential risks associated with infective endocarditis, it is generally more advisable to err on the side of caution and prescribe antibiotic prophylaxis for dental implant procedures in these patients.

Please note that this is a general recommendation and individual patient factors must be considered. Always consult with your healthcare provider for personalized medical advice.


  • Infective Endocarditis: An infection of the inner lining of your heart (endocardium).
  • Antibiotic Prophylaxis: The use of antibiotics before surgery or a dental procedure to prevent a bacterial infection.
  • Pascal’s Wager: A philosophical argument put forth by Blaise Pascal that, given the benefits and risks associated with belief in God, it is more rational to believe in God than not to believe.
  • Platelet Design: The structure of an implant that supports the natural maintenance and remodeling of bone.
  • Locking Taper Design: A type of implant design that creates a bacterial seal, reducing the risk of infection and peri-implantitis.
  • Ultrashort Bicon Implants: A type of dental implant that is shorter in length, making it possible to utilize the existing bone structure effectively.

Dr. Michael Truppe
Facharzt für Zahn-, Mund- und Kieferheilkunde

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2 responses to “Applying Pascal’s Wager to Antibiotic Prophylaxis Decision for Patients with Infective Endocarditis Undergoing Dental Implant Surgery”
  1. Ish Avatar

    What is the appropriate antibiotics to give for endocarditis?

  2. Michael Truppe Avatar
    Michael Truppe

    I took the script from

    ChatGPT Generative Pre-trained Transformer and Zhavoronkov, A. (2022) ‘Rapamycin in the context of Pascal’s Wager: generative pre-trained transformer perspective’, Oncoscience, 9, pp. 82–84.

    Shaw, D. and Conway, D.I. (2010) ‘Pascal’s Wager, infective endocarditis and the “no-lose” philosophy in medicine’, Heart , 96(1), pp. 15–18.

    I am curious about the potential for bias in LLM models. Specifically, when I ask a question such as “I had an accident yesterday and lost a front tooth,” the AI system responds with empathetic phrases like “I’m sorry to hear that.”

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