Keep Those Teeth Clean or else...

Several years ago I saw a patient in the hospital for bacterial endocarditis. Bacterial endocarditis is an infection of the heart lining or valves. It is a very serious condition requiring intravenous antibiotics for at least one month. The patient was a young male with a relatively unremarkable medical history. Upon examination, he was found to have multiple dental cavities with gingivitis. Poor dentition is a cause for infective endocarditis! Then, several months ago, I was involved in a young female who was admitted due to strokes from endocarditis. After an extensive evaluation, it was presumed that the infection was from her oral cavity.

Infective or bacterial endocarditis affects about 29,000 individuals yearly. Individuals with heart conditions such as prosthetic valves, history of rheumatic carditis, congenital disease, or Marfans syndrome are at risk. The source of infection may come from IV drug use, dental procedures, GI procedures, urinary and prostatic procedures, skin infections, colon cancer, cardiac surgery, or respiratory infections. The bacteria enters the bloodstream and settles onto the heart. A vegetation or infective mass develops on the valve resulting in a cascade of signs and symptoms such as fever, rash, joint pain, fatigue, cough, weight loss, skin lesions, trouble breathing, etc...

One important preventative task is to keep those teeth clean. Routine brushing, flossing, and dental visits will keep the bacteria from developing and seeding into the body.

Antibiotics during dental procedures may be used to prevent endocarditis in high risk individuals. A single dose of Amoxicillin or Clindamycin is typically given one hour prior to the procedure. Guidelines suggest antibiotic prophylaxis in treatments involving gingival or tooth root manipulation.

The following conditions should receive antibiotics:
1. People with artificial heart valves
2. Certain congenital heart disease conditions
3. Previous history of endocarditis
4. Cardiac transplant

Mitral valve prolapse is not an indication for antibiotics.

Practice good oral hygiene and keep brushing those teeth!
For more information, talk to your health care professional and dentist. Thanks!