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The role of dentists in the prevention of bacterial endocarditis


Dr Ivan Minic

Background: Endocarditis is a rare, life-threatening inflammation of the lining of the heart muscle and its valves. It is caused by a bacterial infection. Bacterial endocarditis is a disease caused by a bacteremia that affects different organs or tissues, including the oral cavity. Although it has a low incidence, it might imply a potential threat to the life of the affected individual. Predominantly it tends to develop on cardiac valves previously damaged, the mitral valve being its most frequent location, followed by the aortic and in rare occasions the pulmonary valve.Various micro-organisms have been implicated as causative agents for bacterial endocarditis, including lactobacilli and in particular the viridans streptococci which are more commonly associated with dental caries. Of these, the most frequently isolated one has the descriptive name Streptococcus sanguis. In many countries there are national guidelines in order to use antimicrobial prophylaxis having a bacterial endocarditis condition, in case a dental surgery is needed. The reduction of bacteremia, preventing the adherence of bacteria to the endocardium, is the main benefit of the use of prophylaxis. Administering antibiotic prophylaxis to risk patients in countries where national guidelines for antibiotic prophylaxis are provided. For instance, the American Dental Association (ADA), the Infectious Diseases Society of America (IDSA) and the Pediatric Infectious Diseases Society (PIDS)recommended to use antibiotic prophylaxis in dental procedures but only for patients in high-risk situations. These cases include: A prior history of infective endocarditis (IE), a prosthetic heart valve, pulmonary shunts or surgically constructed conduits. Additionally, prophylaxis is limit to dental treatments including those involving dentogingival manipulation. The role of dentists in the prevention of bacterial endocarditis is very important. Continuous education of doctors is necessary in order to reduce the percentage of bacterial endocarditis in the world.



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