Infective endocarditis relation with dentistry:
!. The similarity between the microorganisms
2. Symptoms observed in patient just few weeks after an extraction.
Disease caused by accretion of bacterial vegetation heart valves. The bacterial endocarditis and sepsis and the relation with access site of the organisms are inter-related. Streptococcus viridans, Staphylococcal organisms ( S.aureus) accounts in majority of cases. In cases of AV-Shunt or Synthetic Grafts (fistula) sutured in place, increases the risk of bacterial colonization. The risk of getting infected is high in the first 3 weeks till 3 month of a surgery. The declination of the risk is caused by pseudointima and endothelialization.
The disease is much more evident in patients with previous defects in the heart valve. This also has increased in patients who are under hemodialysis. Change in fluid volume and rate of flow of blood through the heart determines the mechanical stress on the valve which indirectly facilitate the onset of the disease as this damages the valve ,giving a rich site for bacterial growth.
Site of entry of infection can be the caries in the grossly decayed tooth or in cases of periodontitis. These micro-organism enters the blood stream and starts to move towards the heart through veins and finally reaches the venacava .there after these bacteria enters the heart and as the valves are already defective ,it creates an opportunity to there bacteria to colonize in this rich environment resulting in Sub-Acute Bacterial Endocarditis. This is also accompanied by fever and sudden alteration in vital signs. In some patients severe anorexia, palpitation, syncope and nausea might be observed. This infection can also be cause from renal disorders, immune-dysfunctions, hepatitis, and tuberculosis problems along with the associated dental problems. Aggressive grafting in periodontically weak patient with reduces immunity, has a greater risk of such disease. Age is another criteria, which determines the rate of its spread and the ability of the body to fight back.
Dental consideration in such patients is equally important due to the virulence of the bacteria . proper medical history must be considered along with any incidence of a major operation . The condition of the heart and previous infections needed to be clarified with the patient and with their family physicians. The renal condition and the hepatic state determines the antibiotic to be prescribed along with the help of culture sensitivity, the prophylactic dose should always be prescribed by the dentists or associates previous to any treatment. Patients should be more motivated and educated about the consequences of poor oral hygiene, presence of carious too should be immediately treated and any possible entry point should be blocked using specialized techniques. A complete oral prophylaxis must be done in every 3-4 month time interval. Patients must be educated about the benefits of using fluorinated toothpaste and a regular use of mouthwashes after meals.
Selection of proper conditions and precautions are very important to control the spread of infection. Medically compromised patients are needed to be taken special care of and improving the oral hygiene must be the primary consideration to prevent infection.
To Avoid and what must be done by the patients:
Maintenance of Oral hygiene
Don’t hurry dental procedures and encourage doctors extracting without proper prophylactic doses of antibiotics, which is essential to prevent the spread of the disease.
Confirm the safety during blood transfusion
Inform the doctors of any disorder related to health, which will actually protect you from any future complications.
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