Valvular heart disease and heart failure: dental management considerations

Dental Instrumentation Leading to Multivalvular Vegetation Endocarditis in an Otherwise Healthy Immunocompetent Patient Requiring Double Valve Replacement

Infective endocarditis (IE) is a severe condition associated with significant morbidity and mortality, often caused by bacterial seeding. Dental procedures are a well-known and well-documented risk factor for this disease. The authors present a case involving an otherwise healthy 58-year-old male with no cardiac risk factors who developed IE following a dental crown preparation. The patient's dental-induced IE could not be managed medically due to bacterial abscess formation in the mitral and aortic valves. As a result, he developed both mitral and aortic valvopathies, characterized by mild mitral and severe aortic regurgitation, ultimately necessitating mitral valve and aortic valve replacement under cardiopulmonary bypass. This case report highlights the appropriate identification of IE, perioperative evaluation, intraoperative anesthetic management, and a review of echocardiographic findings. A heightened level of clinical awareness was critical for identifying this high-morbidity and high-mortality disease process. The report also reviews the full spectrum of diagnostic and therapeutic interventions in managing an otherwise healthy individual.

Oral health-related quality of life and oral manifestations of Syrian children with congenital heart disease: a case-control study

BACKGROUND

There was an immense need for studies evaluating the oral health status of Syrian children with congenital heart disease (CHD) and its impact on their quality of life. No contemporary data are available. The objective of this study was to investigate oral manifestations and oral health-related quality of life (OHRQoL) of children with CHD and compare them with healthy controls aged 4-12 years.

METHODS

A case-control study was undertaken. A total of 200 patients with CHD and 100 healthy children belonging to the same patient's family were included. Decayed, missed, and filled permanent teeth index (DMFT) and decayed, missed, and filled primary teeth index (dmft), Oral Hygiene Index (OHI), Papillary Marginal Gingivitis Index (PMGI), and dental abnormalities were recorded. The Arabic version of the Child Oral Health-Related Quality of Life Questionnaire (COHRQoL, 36-item) which was divided into 4 different domains (Oral Symptoms, Functional Limitations, Emotional Well-Being, Social Well-Being) were studied. Chi-square test and independent- t-test were used to perform statistical analysis.

RESULTS

CHD patients experienced more periodontitis, dental caries, poor oral health, and enamel defects. The dmft mean was significantly higher in CHD patients than in healthy children (5.245 vs. 2.660, P < 0.05). No significant difference was found between patients and controls in the DMFT Mean (P = 0.731). There was a significant difference between CHD patients and healthy children in the mean of the OHI (5.954 vs. 1.871, P < 0.05), and PMGI (1.689 vs. 1.170, P < 0.05). CHD patients have significantly higher enamel opacities (8% vs. 2%) and hypocalcification (10.5% vs. 2%) than controls. Also, the 4 COHRQoL domains, showed significant differences between CHD children and controls.

CONCLUSIONS

Evidence about the oral health and COHRQoL of children with CHD was provided. Further preventive measures are still required to improve the health and quality of life of this vulnerable group of children.

Oral Hygiene Practice among Hospitalized Patients: An Assessment by Dental Hygiene Students

AIM

An epidemiological study was carried out, in hospital wards, with the aim of assessing the oral health status of patients subjected to multiple medical treatments.

MATERIAL AND METHODS

The study was conducted at Fondazione IRCCS Policlinico San Matteo (Pavia, Italy). A questionnaire was submitted to patients for the evaluation of oral hygiene devices used; then, a clinical examination was conducted to collect Decayed Missing Filled Teeth (DMFT) index, Plaque Index (PI), and Marginal Gingival Index (MGI) values.

RESULTS

Manual toothbrushes were used by a wide range of the sample study (65-100% among hospital wards), together with mouthwash (20-80%); interproximal aids were used by few patients (the lowest recorded value was 33.3%).

CONCLUSION

dental hygienists could be integrated into hospital wards as oral hygiene procedure instructors, for the improvement of the oral health conditions of hospitalized patients.

Endodontics in Systemically Compromised Patients

A substantial number of people in today’s world are elderly and as the incidence of a number of pathologies increases with age, it is predicted to produce millions of individuals with systemic medical conditions that can affect oral health and subsequent dental treatment. The dental management of these medically compromised patients can be sometimes problematic in terms of oral complications, dental therapy, and emergency care. One of the challenges faced by dental specialists today is the assessment and management of these patients. As mentioned in detail in Chap. 12, geriatric patients are much more likely to be at least partially dentulous having a complex medical history and the use of multiple medications.

Oral health and heart failure

Aim. To investigate the association between heart failure (HF) and oral health. Material and methods. The study included 57 patients, aged 50-81 years (mean age 63,6±8,2 years), with Functional Class 0-II HF. Stomatological clinical status and functional status of circulatory system were assessed. Results. HF progression was associated with increased number of carious teeth and missing teeth. In HF-II, the disorders of temporomandibular joint and masseter muscles were 8 and 5 times more prevalent, respectively, than in HF-0.