Protect Your Heart with Good Dental Hygiene : Understanding the Link Between Oral Health and Bacterial Endocarditis

Bacterial Endocarditis is a rare and life-threatening inflammation of the inner lining of the heart muscle and the heart valves. This bacterial infection can be caused due to several factors, while poor dental health is one of the risk factors for bacterial endocarditis. In rare cases, bacteria in the mount could trigger endocarditis in people at higher risk.

So, there is a link between oral health and bacterial endocarditis. Let us read further to understand this link

The development of bacterial endocarditis requires a complex set of factors that causes certain microbes to adhere to the cardiac endothelium and trigger inflammation.^(1,2) One of the factors that can develop endocarditis could be poor oral health.

Besides many staphylococcus species, oral viridans streptococci play a major role in the development of bacterial endocarditis, particularly in patients with underlying cardiac issues, such as congenital heart disease, valve replacement, and a history of previous bacterial endocarditis. Usually, undetected persisting odontogenic infections and their secondary symptoms, along with certain therapeutic measures for their treatment and prevention, can lead to the transfer of bacteria from the oral cavity into the bloodstream and ultimately lead to bacterial endocarditis.⁽³⁾

According to the American Heart Association, the biggest causes of bacterial or infective endocarditis include poor oral hygiene, minor gum injury caused while brushing, and dental procedures.⁽⁴⁾

Now, let us know how poor oral health can lead to bacterial endocarditis. The actual insight is that bacteria found in tooth plaque can multiply and result in gingivitis (a gum disease). If this is left untreated, it may become advanced. The gums become inflamed, turn red and swollen, and often start bleeding during tooth brushing, flossing, or during specific dental procedures involving the manipulation of the gums. The bacteria can enter the bloodstream when gums bleed, and when bacteria enter the bloodstream, they can infect other parts of the body.

In the case of bacterial endocarditis, this affects the inner lining of the heart and also the surfaces of heart valves. The bacteria adhere to these surfaces and create growths of more bacteria.

To prevent bacterial endocarditis, patients who are at high risk for serious complications from endocarditis or who have certain heart conditions should receive a single dose of an antibiotic before dental procedures. The antibiotic should be received one hour before the dental treatment. Receiving antibiotics before any dental procedures can help in preventing bacterial endocarditis in the patient.

The American Heart Association and American Dental Association, guidelines support premedication for a small subset of patients as a measure of bacterial endocarditis prophylaxis.⁽⁵⁾

Patients undergoing dental procedures should receive antibiotics if they have the following conditions.

• Had bacterial endocarditis earlier.
• Have cardiac valve disease and have had a cardiac transplant,
• Have a prosthetic cardiac valve or prosthetic material has been used in valve repair.
• Presence of congenital heart disease.

It is essential to take proper oral care and keep bacterial endocarditis (caused due to poor oral hygiene) at bay. Below are some ways to take proper oral care and prevent bacterial endocarditis.

• Visit your dentist at regular intervals and let your dentist know if you have had heart or vascular surgery within the past six months. You should also report to your dentist if you have been diagnosed with any other heart condition.
• Let your dentist know the list of names and dosages of medications that might be taking.
• Your dentist should have the names and numbers of all your doctors so that a proper dental care plan and medication choices could be possible.
• Practice proper oral hygiene. Brush your teeth, at least twice a day, floss at least once every day, and rinse with an antiseptic mouthwash at least once daily.

Bacterial endocarditis is a rare but life-threatening inflammation of the inner lining of the cardiac muscle and heart valves. Although this bacterial inflammation can be caused due to multiple factors, one of the major factors could be poor oral health. Somehow, oral health and bacterial endocarditis are linked to each other. Congenital birth defects, having an artificial heart valve or pacemaker, and having bacterial endocarditis before, are some of the risk factors for developing bacterial endocarditis. So, patients with these risk factors should practice good oral hygiene which would help in reducing the risk of developing endocarditis.

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