Abstract
Infective endocarditis is an extremely serious disease that can present with a variety of clinical manifestations, including infection of valves and endocardium, in patients with cardiac disease, and is associated with risk factors such as invasive dental procedures, caries, and periodontal disease. On the other hand, it has been shown that perioperative oral function management before various surgeries, such as those for malignant tumors, cardiovascular disease, and transplantation, may prevent or reduce postoperative complications. Close coordination between the dentist and cardiac surgeon is especially necessary before heart valve surgery because of the risk of severe complications. The number of perioperative oral management procedures being performed in community dental clinics is increasing. In the absence of clear guidelines, the physician-in-charge usually determines how to best perform oral management while considering the patient’s needs. We report a case of infective endocarditis occurring after perioperative oral management in a young patient with good oral hygiene. This case shows that standardization of the techniques and widespread dissemination of the guidelines are required. Patients should be counseled regarding the importance of maintaining oral hygiene from a young age.This case report should act as a cautionary tale not only for hospital clinicians but also for community medical and dental practitioners, as the number of such patients is expected to increase in the future.
Highlights
Infective endocarditis (IE) is a systemic septic disease characterized by the formation of vegetations containing bacterial communities on the valves, endocardium, and endothelium of large vessels
There are no criteria for proper selection and treatment of the patients, and all decisions regarding Perioperative oral function management (POM) are made by the dentistin-charge
There were two possible routes of infection, namely, invasive dental procedures performed during POM, and chronic dental caries resulting in bacteremia during eating and brushing
Summary
Infective endocarditis (IE) is a systemic septic disease characterized by the formation of vegetations containing bacterial communities on the valves, endocardium, and endothelium of large vessels. Perioperative oral function management (POM) is one of the most important dental procedures for preventing the development of IE. Transthoracic echocardiography revealed no evidence of decreased cardiac function or presence of vegetations He was admitted for surgery 10 days after POM. On the fourth day of hospitalization, Streptococcus mutans was detected in all blood cultures taken at the time of hospitalization, and transesophageal echocardiography revealed mitral regurgitation with vegetations, which had not been observed before (Figure 1). These findings led to a definitive diagnosis of IE according to the modified Duke criteria [5]. The patient underwent valve replacement and valvuloplasty and the postoperative course was good
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