Infective endocarditis and orthodontic implications in children: A review of the literature

Abstract

Owing to access to high-quality medical care, more medically compromised patients are seeking orthodontic therapy, including those at risk of developing infective endocarditis (IE). The current guidelines for orthodontic therapy and IE are few. The objective of this review is to provide an evidence-based update on the relationship between orthodontic procedures and IE in children. A comprehensive review of the English language literature available through PubMed, Ovid Medline, and Google Scholar without any limits of years of publication was conducted to analyze the evidence regarding IE and orthodontics. A necessary prerequisite for IE is bacteremia. Although the only orthodontic procedure included in the current American Heart Association guidelines is the placement of bands, placement of separators has also been found to lead to significant bacteremia. Procedures with possible clinical significance include removal of expanders, placement of separators, and placement of bands. Because of the unavailability of high-quality evidence, elective invasive procedures prone to causing bacteremia should be avoided. Evidence regarding orthodontic treatment and IE is limited because of ethical considerations of conducting trials in patients who are at risk for IE. Clinical interpretation based on a comprehensive review of the available literature is therefore essential. Before initiating orthodontic therapy in cardiac patients, the patient's IE risk is best determined by referring to the current American Heart Association guidelines and through consultation with the patient's cardiologist. Procedures that can lead to tissue injury or bacteremia should be avoided. Oral hygiene must be reinforced because inflammation influences bacteremia.