Oral bacteria such as viridans streptococci can cause cardiac disease primarily by:

Dental manipulation can cause a transient bacteremia; circulating oral streptococci adhere to previously damaged or prosthetic valves and endocardium and form vegetations (infective endocarditis). This is the rationale for antibiotic prophylaxis in the highest-risk cardiac patients.Other options: Oral bacteria do not ascend nerves to the heart, and fluoride release is irrelevant to endocarditis.Key exam takeaway: Bacteremia leads to seeding of susceptible valves = infective endocarditis, the basis for prophylaxis in high-risk patients.