Endocarditis

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Vol. 93 No. 6 June 2002

ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY ORAL MEDICINE
Editor: Martin S. Green

An update on the controversies in bacterial endocarditis of oral origin
Inmaculada Tomas Carmona, DDS,a Pedro Diz Dios, MD, PhD, DDS,b and Crispian Scully, ´ MD, PhD, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci,c Santiago de Compostela, Spain, and London, UnitedKingdom
SANTIAGO DE COMPOSTELA UNIVERSITY AND UNIVERSITY COLLEGE LONDON

Objectives. The aim of this review was to evaluate the evidence implicating dental procedures in bacterial endocarditis (BE) development and the basis for antimicrobial prophylaxis (AP). Study design. In this article, the literature is reviewed and meaningful findings about epidemiology, pathogenesis, and AP guidelines for BEof oral origin are highlighted. Available results are used to formulate clinical recommendations for the dental practitioner. Results. The nature of dental procedures that cause bacteremia, patients at risk for BE, and the effectiveness of AP guidelines, continue to be points of controversy. There appears to be further evidence to support the important role of oral health status in the preventionof BE of dental origin. Conclusions. One objective of the dental practitioner in caring for patients at risk for BE should be to promote oral health care. There are no hard data on which to scientifically base the need for AP in patients at risk for BE. However, it would appear prudent, at least from the medicolegal perspective, to provide AP, at least to persons with previous BE or prostheticheart valves and to those undergoing oral surgery, periodontal treatment, or implant placement. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:660-70)

One of the first descriptions of bacterial endocarditis (BE) was attributed to Lazare Riviere [cited by Major1], ` who, on examining a corpse in 1646, stated: “In the left ventricle of the heart, round caruncles were found with anappearance like that of the substance of the lungs, the largest of which resembled a cluster of hazel nuts filling the opening of the aorta.” Osler,2 in 1885, described the typical anatomopathologic findings of BE in a series of autopsies, coined the term malignant endocarditis because of the fatal outcome in all cases.

DEFINITION BE is an infection that affects the endocardium in valvular, mural, andseptal defects, as well as in arteriovenous and arterioarterial short-circuits.3 INCIDENCE The true incidence of BE is difficult to ascertain, because in most published series, data have been collected retrospectively and the inclusion criteria used have not been homogenous. The estimated frequency varies from between 1 and 5 cases/100,000 population/ year4-9 and has increased in recent years,especially in the elderly.9-12 Hogevik et al9 in a prospective study in Sweden detected 20 cases/100,000 inhabitants/year among patients older than 70 years of age. BE is generally less frequent in the young, except in intravenous drug users (IDUs) who are at such risk13 that in some series they represent half the cases of BE.14 BE rarely affects children; the incidence is approximately 0.3cases/100,000 children/year, and the main predisposing factors in more than 90% of the infantile cases

a

Research Fellow, School of Dentistry, Santiago de Compostela University, Spain. b Assistant Professor, School of Dentistry, Santiago de Compostela University, Spain. b Professor and Dean, Eastman Dental Institute for Oral Health Care Sciences, University College London, United Kingdom. Received forpublication Jul 2, 2001; returned for revision Oct 18, 2001; accepted for publication Dec 4, 2001. Copyright © 2002 by Mosby, Inc. 1079-2104/2002/$35.00 0 7/13/122338 doi:10.1067/moe.2002.122338

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ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY Volume 93, Number 6

Tomas Carmona, Diz Dios, and Scully 661 ´

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