Infective endocarditis: Updated guidelines

U Allen Paediatr Child Health Vol 15 No 4 April 2010

TARGET GROUPS FOR PROPHYLAXIS

Prosthetic cardiac valve or prosthetic material used for valve repair Previous IE CHD Cardiac transplant recipients who develop cardiacvalvupathy

The procedures for which prophylaxis is reasonable are as follows:

All dental procedure s that involve the manipulati on of

Gingiva l tissue

Periapical region,perf orasi oral mucosa

The following procedures and events do not require prophylaxis

anesthetic injections
adjustment of orthodontic appliances

taking dental radiographs

shedding of deciduous teeth

placement of removable prosthodontic

bleeding from trauma to the lips or oral mucosa

Antibiotic regimens for dental procedures

SUMMARY
The 2007 AHA guidelines are significantly different from previous guidelines
The AHA Committee recognizes the need for more data to guide future changes to the IE prophylaxis guidelines.

Can a chronic dental infection be considered a cause of cardiovascular disease?a review of the literature
Elisabetta Cotti a, Cristina Dess a, Alessandra Piras b, Giuseppe Mercuro b, E. Cotti et al. / International Journal of Cardiology (2010) -12803

INTRODUCTION
Cardiovascular disease have a complex etiology determined by risk factors, genetic component environmental factors

INTRODUCTION
Apical periodontitis Periodontal disease

Dental infection

CVD

Period ontal diseas e

Apical period ontitis

Common microbiota

PERIODONTAL DISEASE AND CVD

Relationship between periodontal infection and artherosclerosis mattil Dental health worse Periodontal disease as an predictor of a myocardial infarction risk

25% increase in CHD in the patients who were clinically diagnosed with periodontal De disease. stefano the total mortality was higher in patients with periodontal disease and CHD than in those with CHD and healthy periodontium.

APICAL PERIODONTITIS AND CVD Title

Endodontic non surgical procedures of root canals during endodontic treatments can produce a transient bacteremia

APICAL PERIODONTITIS AND CVD

joshipura frisk caplan

Strong association between a positive self-reported history of Endodontic Treatment incidence of CHD

No significant association between AP and CHD and socio-economic risk factors and AP respectively.

Association of self-reported history of ET among participants with 25 or more teeth, with CHD

Two examples of periapical bone lesions of endodontic origin (arrowed)

CONCLUSION
periodontal disease may occur together with some forms of CVD or represent an oral manifestation of the same disease.

Apical periodontitis is widely present in endodontically treated teeth Only a more focused and rigorous scientific research can determine a definitive opinion on the relationship between endondontic disease and cvd.

Infective Endocarditis Prophylaxis for Dental Procedures in 2009: What Has Changed?

Hellenic J Cardiol 2009; 50: 493-497

INTRODUCTION

infective endocarditis attributable to an invasive procedure bacteremia resulting from daily activities is much more likely to cause infective endocarditis

antibiotics by limiting bacteremia effective in preventing infective endocarditis associated with dental procedures

Dental procedure
Daily activities

Bacteremia

Lockhart et al shown a incidence of bacteremia (23%) from brushing, i

brushing poses a risk for bacteremia similar to that of a dental extraction,

recommend toothbrushing at least twice per day.

 The presence of dental disease may increase the risk of bacteremia bacteremia due to poor dentition may pose a much greater risk for the development of infective endocarditis

GUIDELINES
Antibiotic infective endocarditis prophylaxis should be given only to high-risk patients prior to dental procedures

1 2

Antibiotic infective endocarditis prophylaxis is no longer mandatory

GUIDELINES
High-risk patients are defined not on the basis of an increased risk for infective endocarditis Antibiotic infective endocarditis prophylaxis is no longer indicated in patients with native valve disease

3 4

The recommended antibacterial regimens for dental procedures

CONCLUSIONS
For high-risk cardiac patients subjected to indicated dental procedures, it is reasonable to follow the recent AHA guidelines