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 Some previous research has linked dental work to an increased risk
of what’s known as infective endocarditis - infections of the heart
valve or lining - in people with prosthetic valves, but results have
been mixed and inconclusive about whether antibiotics would prevent
these infections.
For the current study, researchers examined data on 138,876 adults
with prosthetic heart valves, roughly half of whom had at least one
dental procedure during the study period. About 26 percent of the
dental work involved invasive procedures, and patients received
antibiotics in only half of these cases.
Patients who had invasive dental procedures were 66 percent more
likely to develop these infections than people who didn’t have
invasive dental work, researchers report in The BMJ.
“Although the risk of infective endocarditis is low it is reasonable
to offer the option of antibiotic preventive strategy prior to
dental procedures because it is life threatening,” said lead study
author Sarah Tubiana of INSERM in Paris.
“Invasive dental procedures such as tooth extraction or scaling
disrupt gingival integrity and allow bacteria in the mouth to enter
the bloodstream; then, the bacteria can graft on cardiac valves and
destroys valves,” Tubiana said by email.
Infective endocarditis is a rare but severe disease that kills one
in five people hospitalized for the condition and has a five-year
mortality rate of 40 percent, researchers note.
Researchers followed half of the people in the current study for at
least 1.7 years and during that time, 267 individuals developed
endocarditis associated with streptococcus bacteria that live in the
mouth.
The study team looked at endocarditis rates in the three-months
after invasive dental work and compared infection rates to what
happened to individuals who didn’t have invasive dental procedures.
During the three months after invasive dental work, 5.1 percent of
patients developed endocarditis, compared with 3.2 percent during
periods without dental procedures.
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Among people who had invasive dental procedures, the endocarditis
rate was lower for those who got antibiotics at the time, but the
difference was too small to rule out the possibility it was due to
chance.
The study wasn’t a controlled experiment designed to prove that
dental work directly causes endocarditis or that antibiotics might
prevent these infections.
Indeed, the authors note that while dental procedures were linked to
slightly higher rates of these heart infections, they are not the
main source of risk for heart valve patients, since the majority of
infections across the entire study population occurred in people who
didn't have recent dental work.
“Dental procedures are only one cause of infective endocarditis, and
bacteria can get into the bloodstream simply during the course of
daily life - for example through chewing or tooth brushing,” said
Dr. Tom Cahill, co-author of an accompanying editorial and a
researcher at Oxford Heart Centre in the UK.
“The most important thing is that patients with valve disease are
aware of endocarditis, and seek urgent medical attention if they are
worried they have developed any of the symptoms,” Cahill said by
email.
Symptoms can be similar to the flu and include fever, sweats, chills
and aching muscles or joints, he said. Some people with these
infections may also have swollen glands, headache, cough, fluid
buildup on the chest or legs or breathlessness.
SOURCE: http://bit.ly/2f9lfBd The BMJ and http://bit.ly/2y1pum9,
online September 7, 2017.
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