Pre- and Post-operative Dental Focus of Patients with Prosthetic Heart Valves

摘要

Introduction and Aim: Patients who are going to receive prosthetic heart valve operation should have all indicated dental treatment performed before the valve is placed since they are more susceptible to infective endocarditis or to prosthetic valvular endocarditis arising from oral infections. The aim of this study is to evaluate the incidence of potential odontogenic infections sources in patients with pre- and post- prosthetic heart valve operations.Materials and Methods: Twenty patients with pre- and postoperative valves replacement were subjected to comprehensive clinical and radiographic dental examination. Information considering age, gender, oral pathological features like periapical periodontitis, cysts, remained roots, impacted teeth, the existence of current diabetes mellitus and the form of the valve replacement were also included in the documentation.Results: Patients who were examined after prosthetic heart valve operation showed relatively more dental problems, more past canal treatments and more chronic periodontitis than patients who were examined before prosthetic heart valve replacement. Conclusion: Optimized dental treatment planning for patients scheduled to undergo cardiac valve replacement is always a need. Optimal cooperation between the cardiologist and the dentist is to be considered. The need of prophylactic antibiotics before and after several dental manipulations should be always discussed. Introduction Valvular heart diseases include a variety of congenital and acquired disorders that are of importance to the dentist for two reasons; first, disorders of the cardiac valves can adversely affect cardiac performance and place dental patients at risk for cardiac emergency and second, some disorders of the cardiac valves can increase patient risk for having infective endocarditis which develops as a result of oral flora bacteremia.Medical risk assessment for dental patients with valvular heart diseases is principally concerned with 3 issues:Cardiac functionProgressive valvular heart disease results in an imbalance of myocardial oxygen demand and supply leading to ventricular dysfunction, cardiac ischemia, and increased risk for heart failure. During a period of compensation, the heart rate and force might increase to maintain cardiac output. Such compensation can be at the expense of cardiac reserve to respond to cardiovascular stress (1).Potential for altered hemostasisMany valvular disorders will require anticoagulation due to the risk for thrombus formation either at the site of the injured valve or at the site of myocardium. All prosthetic valves increase the risk for thromboembolism, although risk is minimal or negligible for the porcine bioprosthetic valve. For any patient taking an anticoagulant, both the dentist and the physician must assess the risk for altered bleeding after an invasive dental and/or oral procedure. Assessment includes the magnitude of the invasive procedure, the patient's bleeding history and a bleeding profile which will generally include the prothrombin time (PT), partial thromboplastin time (PTT) and the international normalized ratio (1,2)Infective endocarditisInfective endocarditis (3) is an infection of the heart valveolar endocardium. Although it might result form a bacteremia originating from any site and representing almost any species, it is of interest to the dentists as it relates to the oral bacterial flora as a potential source for bacteremia and endocarditis. IE is an uncommon but potentially fatal disease. The onset of IE after bacteremia can vary from weeks to months, and diagnosis is confirmed by blood culture and echocardiogram. IE can lead to death caused by heart failure or acute thromboembolic events (1). There are conditions associated with increased risk for IE, but the risks associated with the initiating bacteremia are less well studied. For instance, although it is well established that mitral valve prolaps with regurgitation is a significant risk f