Infective Endocarditis Flashcards
What is infective endocarditis?
An infection of the endocardium - most commonly the heart valves.
What microorganisms causes infective endocarditis?
Commonly oral microorganisms
i.e. Viridian’s streptococci
Describe the process of infective endocarditis causing damage to the valves/endocardium.
Surface abnormality on the valve/endocardium.
Abnormality causes a haemodynamic change to the flow.
Turbulent blood flow encourages platelet/fibrin deposition on the valves/endocardium.
Thrombus is colonised by the bacteria (from the oral cavity which has gone systemic via toothbrushing/extraction/ per treatment etc)
Colonisation causes the vegetations to form on the valve
The vegetations continue to enlarge until they cause damage to the valve tissue itself or cause damage which leads to the spread of the bacteria to the endocardium.
What are the signs of infective endocarditis?
Heart murmur
Splinter haemorrhages (blood clot under the nail)
What are the consequences of infective endocarditis?
Structural defects to the heart i.e. valve dysfunction and damage to the endocardium.
Death
How is infective endocarditis treated?
IV antibiotics for > 4 weeks
Valve replacement
Who is at high risk of getting infective endocarditis?
Those who have had infective endocarditis previously
Those with congenital heart disease i.e. atria/ventricular septal defects, patent ductus arteriosus or great vessel malformations.
Those with valve disease i.e. calcific aortic stenosis and rheumatic heart disease.
Those with valve replacements
What is the dental relevance in terms of infective endocarditis?
Infective endocarditis commonly caused by oral bacteria.
Bacteria accumulates in patients with poor oral hygiene.
Since there are more bacteria present in a patient with poor oral hygiene, the bacteria is more likely to go systemic during various procedures and toothbrushing.
What dental procedures increase the risk fro infective endocarditis?
Any procedure involving the dento-gingival margin.
Periodontal therapy
Implants
Extractions
Restorations near the gingival margins or restorations where a matrix band is required.
In terms of aesthetics and body modifications; what should be avoided in those with a high risk for infective endocarditis?
Tongue piercings
What is the outlook on antibiotic prophylaxis in patients with infective endocarditis?
Not routinely recommended.
Describe the stages that must be taken before treating a patient with endocarditis.
Take a medical history to establish if the patient is high risk.
Reduce the size and risk of the oral bacteraemia via;
Oral hygiene instruction
Removal of unrestorable carious teeth and teeth that may cause infection.
If treatment near the dento-gingival margin has to be carried out;
Patient must confer with their physician and decide if they want antibiotic prophylaxis.
The patient must be told the consequence of having antibiotic prophylaxis or not having antibiotic prophylaxis.
If the patient decides to have antibiotic prophylaxis, written consent must be obtained by the dentist.
Prophylaxis must be taken in the dental surgery under the supervision of the dentist 1 hour before the treatment.
Why must antibiotic prophylaxis be taken in the dental surgery under the supervision of the dentist?
So that if there is an adverse drug reaction the appropriate first aid can be carried out.
What antibiotic drug is given as prophylaxis?
Amoxycillin 3g - orally
