cardiovascular-agents and Endocarditis--Bacterial

Cardiovascular diseases represent a widespread heterogeneous group of conditions that have significant morbidity and mortality. The various diseases and their treatments can have an impact upon the periodontium and the delivery of periodontal care.. In this paper we consider three main topics and explore their relationship to the periodontist and the provision of periodontal treatment.. The areas reviewed include the effect of cardiovascular drugs on the periodontium and management of patients with periodontal diseases; the risk of infective endocarditis arising from periodontal procedures; the inter-relationship between periodontal disease and coronary artery disease.. Calcium-channel blockers and beta-adrenoceptor blockers cause gingival overgrowth and tooth demineralisation, respectively. Evidence suggests that stopping anticoagulant therapy prior to periodontal procedures is putting patients at a greater risk of thromboembolic disorders compared to the risk of prolonged bleeding. The relationship between dentistry and infective endocarditis remains a controversial issue. It would appear that spontaneous bacteraemia arising from a patient's oral hygiene practices is more likely to be the cause of endocarditis than one-off periodontal procedures. The efficacy of antibiotic prophylaxis is uncertain (and unlikely to be proven), and the risk of death from penicillin appears to be greater than the risk of death arising from infective endocarditis. Finally, the association between periodontal disease and coronary artery disease has been explored and there seem to be many issues with respect to data handling interpretation. Many putative mechanisms have been suggested; however, these only further highlight the need for intervention studies.

Topics: Bacteremia; Cardiovascular Agents; Cardiovascular Diseases; Coronary Disease; Endocarditis, Bacterial; Humans; Periodontal Diseases; Periodontium; Risk Factors

Topics: Arteriosclerosis; Cardiovascular Agents; Cardiovascular Diseases; Embolism; Endocarditis, Bacterial; Eye Diseases; Giant Cell Arteritis; Humans; Medical History Taking; Ocular Hypertension; Retinal Vein Occlusion; Syndrome

Topics: Cardiovascular Agents; Dentistry; Endocarditis, Bacterial; Heart Diseases; Humans; Hypertension; Mouth Diseases; Oral Hygiene

The provision of dental treatment under both local anaesthesia and sedation has an excellent safety record, although medical problems may occur. The high prevalence of cardiac disease in the population, particularly ischaemic heart disease, makes it the most common medical problem encountered in dental practice. Additionally, the increasing survival of children with congenital heart disease makes them a significant proportion of those attending for dental treatment. While most dental practitioners feel confident in performing cardio-pulmonary resuscitation, treating patients with co-existent cardio-vascular disease often causes concern over potential problems during treatment. This article aims to allay many of these fears by describing the commoner cardiac conditions and how they may affect dental treatment. It outlines prophylactic and remediable measures that may be taken to enable safe delivery of dental care.

Topics: Anesthesia, Dental; Angina Pectoris; Anticoagulants; Arrhythmias, Cardiac; Cardiovascular Agents; Dental Anxiety; Dental Care for Chronically Ill; Drug Interactions; Emergency Treatment; Endocarditis, Bacterial; Heart Defects, Congenital; Heart Diseases; Heart Valve Diseases; Humans; Hypertension; Monitoring, Intraoperative

Topics: Cardiovascular Agents; Endocarditis, Bacterial; Global Health; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Morbidity

Topics: Acute Coronary Syndrome; Anti-Bacterial Agents; Cardiobacterium; Cardiovascular Agents; Coronary Angiography; Dental Caries; Echocardiography, Transesophageal; Embolism; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mitral Valve Insufficiency; Treatment Outcome

Topics: Anesthesia, Dental; Angina Pectoris; Arrhythmias, Cardiac; Cardiovascular Agents; Cardiovascular Diseases; Dental Care for Chronically Ill; Endocarditis, Bacterial; Humans; Medical History Taking; Physical Examination; Risk Factors; Vasodilator Agents

From 1972 to 1980, 23 patients (Group A) with native valve infective endocarditis underwent surgical intervention, often for multiple indications, during the active stage of the infective process because of progressive class III and IV (New York Heart Association) heart failure (12 patients), persistent severe hypotension (3 patients), uncontrolled infection for over 21 days (11 patients), aortic root abscess (2 patients), and pericarditis (1 patient). Eighty-five patients (Group B) with active native valve endocarditis, matched for severity of illness, were treated medically. Two patients (9%) in Group A and 43 patients (51%) in Group B died during the hospital admission (p less than 0.001). Any difference in long-term cumulative survival rate between the 2 groups was largely due to the beneficial impact of surgical management on the hospital mortality. Of 23 patients in Group A, 11 (48%) had an entirely uncomplicated postoperative course. Long-term mortality rates in those with aortic valve endocarditis treated medically (79%) were significantly higher than in those with mitral valve involvement (47%) (p less than 0.05). Patients with aortic valve involvement treated surgically had a better hospital (p less than 0.005) and long-term (p less than 0.0005) survival rate than those treated medically. Two groups at risk for postoperative complications were identified; 3 of 11 patients (27%) with uncontrolled infection had an early postoperative recurrence, and 4 of 7 patients (57%) with an aortic root abscess had postoperative prosthetic paravalvular regurgitation. Surgery therefore effects a substantial reduction in hospital mortality in patients with complicated active infective endocarditis (9% versus 51%), but patients with preoperative prolonged periods of uncontrolled infection or with aortic root abscess are liable to postoperative complications.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cardiovascular Agents; Child; Endocarditis, Bacterial; Female; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Prognosis