Periodontal treatment dangerous for the heart

Periodontal treatment can be dangerous for the heart

14/09/2012

For patients with heart problems, dental procedures can be a risk. Therefore, cardiac patients should submit their cardiological examination passport before being treated by the dentist. Often a so-called endocarditis prophylaxis with antibiotics is recommended to exclude desirable consequences for the heart.

New guidelines for dentists do not protect patients from heart disease
The German Society of Cardiology has written special guidelines for dentists, so that cardiac patients in dental treatments no threat to health. Cornelia Piper, cardiologist and scientist at the Heart and Diabetes Center NRW (HDZ NRW), has now for the first time examined in a study whether and to what extent the new guidelines are effective. The unsatisfactory result for heart patients: "High-risk patients are still well advised to give their cardiological examination pass before dental treatment. The new guidelines of the German Cardiac Society have so far not helped to increase the attentiveness of the dentists in particular with regard to precautionary possibilities for a life-threatening inflammatory heart disease (endocarditis), "it says in the current press release of the HDZ NRW.

Under endocarditis, doctors understand an inflammation of the heart's lining. This covers the heart valves and clothes the heart cavities as well as the arteries and veins close to the heart. If the bloodstream in the heart is changed due to illness, it can cause small injuries by swirling again and again in the same places of the heart skin. If bacteria enter the blood, these sites are particularly susceptible to inflammation. Normally, endocarditis is well treatable with antibiotics. However, if no therapy, the disease leads to the death of the person affected. Particularly at risk are people with congenital or acquired heart defects, especially after a replacement of the heart valves.

"Periodontal treatment can be extremely dangerous for these high-risk patients," explains Piper. "So-called Gram-positive bacteria from the periodontal pockets can enter the bloodstream following numerous dental procedures. The bacteria then prefer to attach to the heart valves and multiply. Endocarditis is the result. "According to the guidelines of the German Society of Cardiology, high-risk patients should undergo endocarditis prophylaxis, an antibiotic therapy, before undergoing dental treatment. "When taken an hour before the periodontal treatment, the antibiotic causes the bacteria to be able to settle on the heart valves in small quantities at most. This significantly reduces the risk of inflammation of the heart's lining, "says the doctor.

Risk to the heart is reduced by antibiotic therapy
By 2007, prior to the entry into force of the new guidelines, antibiotic prophylaxis had even been prescribed for patients at lower risk. According to study results of Piper patients were better advised at that time. "The child was released with the bath, so to speak," says the doctor. The dentists would now perform significantly fewer antibiotic therapies even in high-risk patients.

Already in 2003, Piper demonstrated in a previous study that the guidelines for dental treatments pose problems in practice. "It has been shown that the safest way for our patients to present the so-called patient card, which should be provided with the appropriate guidelines to each treating physician," reports Piper. "Also under discussion is the question of whether antibiotic prophylaxis is also recommended for patients with a so-called moderate risk of endocarditis. Currently there is still a lack of reliable data. "(Ag)

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