Bacterial endocarditis. Survey of patients treated between 1963 and 1975

Prevalence of predisposing factors for endocarditis among an elderly institutionalized population

The charts of 100 nursing home patients in a Veterans Affairs skilled nursing facility were reviewed to identify the need for endocarditis prevention prior to dental procedures. Forty-two (42%) had identifiable needs. Systolic murmurs, documented in 38% of the residents, were the most prevalent abnormality. Five patients had other indications for antibiotic coverage (history of rheumatic heart disease, previous endocarditis, artificial heart valve), which added four unique patients (those not already identified by murmurs) to the total. The dental implications of these findings are discussed.

Experimental endocarditis following dental extractions in rats with periodontitis

This study analyzed the development of bacterial endocarditis following dental extraction in rats with periodontal disease. Periodontal disease was produced in rats by tying silk ligatures around the two maxillary first molars, and placing the animals on a high sucrose diet. Sterile aortic valve vegetations were produced by means of a transaortic catheter, and 24 hours later the maxillary first molars were extracted. The animals were killed 72 hours after the extractions. In rats with periodontal disease induced for 10 and 14 weeks, extractions resulted in an incidence of bacterial endocarditis of 24% and 50%, respectively, most of which were due to streptococcal species (two were caused by Staphylococcus [corrected] aureus). The difference, though not statistically significant (p = 0.10, chi 2 with Yates correction), shows a trend toward increased incidence of endocarditis with increasing severity of periodontal disease. This model demonstrates that one can reliably induce bacterial endocarditis after dental extractions in rats with periodontal disease.

The central indwelling venous catheter in the pediatric patient--dental treatment considerations

Dentists need to understand and recognize the special needs of this unique patient population before dental therapy is instituted. The primary objective of this paper is to familiarize the dental practitioner with the central venous catheter and its indications in pediatric medicine. In addition, recommendations concerning the appropriate management of these patients are provided.

The enterococcus

In 1899, Thiercilin used the term “enterococcus” to describe microscopic organisms seen in pairs or short chains in feces. Later (in the 1930s) the name was used in a more restrictive sense for streptococci that had the hardy capacity to survive under extreme conditions.

Enterococci belong to a group D family of streptococci, as characterized by Lancefield in 1938. In contrast to other groups of streptococci, the group D antigen is not a wall carbohydrate but a glycerol teichoic acid containing glucose and D-alanine. This antigen appears to be related directly to the cytoplasm or plasma membrane.

Infective endocarditis: a review and update

Infective (bacterial) endocarditis has presented a "changing face" over the previous years but remains a disease with potentially serious complications. Surveys have indicated that up to 92% of cases of infective endocarditis could be attributed to a dental origin; yet most susceptible persons do not understand their condition or the precautions necessary prior to dental treatment. Up to 80% of infective endocarditis patients received no protection prior to dental or genitourinary manipulation. Dental practitioners, therefore, play an important role in the prevention of this disease and must be familiar with recent developments on the subject. This article provides an in-depth review of the disease and outlines and stresses the dental practitioner's responsibility in its prevention.

Bacterial endocarditis. A retrospective study of cases admitted to the University of Alabama Hospitals from 1969 to 1979

A retrospective study was conducted at the University of Alabama in Birmingham Medical Center on patients diagnosed as having BE from the years 1969 to 1979, with emphasis on dental involvement. A major finding of this report revealed that 16 percent of the cases of BE had a history of recent dental care or pathology. Other results of this investigation included the following: (1) Streptococcus viridans was the predominant microorganism associated with BE; (2) the mortality rate relative to predisposing heart disease was highest for patients with prosthetic heart valves; (3) chronic valvular heart disease was the heart problem most susceptible to BE; (4) chronically abscessed teeth and periodontal disease may be initiating factors of BE.

Experimental endocarditis induced by dental manipulation and oral streptococci

Circumstantial evidence has strongly implicated dental manipulation as an etiologic factor in the development of infective endocarditis. The introduction of human oral streptococci via the oral cavity in rabbits with vegetative cardiac lesions yields a 94 per cent incidence of infective endocarditis, if the number of inoculated organisms is above a threshold level of 10(7).