Statement of Clinical Relevance
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These data provide evidence to support and strengthen American Heart Association guidance that dental plaque and calculus may be risk factors for infective endocarditis, and that improving oral hygiene may reduce the incidence of IE from oral bacterial species.
Abstract
Objective
To determine if oral hygiene is associated with infective endocarditis (IE) among
those at moderate risk for IE.
Study Design
This is a case control study of oral hygiene among hospitalized patients with IE (cases)
and outpatients with heart valve disease but without IE (controls). The primary outcome
was mean dental calculus index. Secondary outcomes included other measures of oral
hygiene and periodontal disease (e.g., dental plaque, gingivitis) and categorization
of blood culture bacterial species.
Results
The 62 case participants had 53% greater mean dental calculus index than the 119 control
participants (0.84, 0.55, respectively; difference = 0.29, 95% CI:0.11, 0.48; p=0.002)
and 26% greater mean dental plaque index (0.88, 0.70, respectively; difference = 0.18,
95% CI: 0.01,0.36; p=0.043). Overall, cases reported fewer dentist and dental hygiene
visits (p= 0.013) and fewer dental visits in the 12 weeks prior to enrollment than
controls (p=0.007). Common oral bacteria were identified from blood cultures in 27
of 62 cases (44%).
Conclusions
These data provide evidence to support and strengthen current AHA guidance that those
at risk for IE can reduce potential sources of IE-related bacteremia by maintaining
optimal oral health through regular professional dental care and oral hygiene procedures.
Key Words
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Article info
Publication history
Accepted:
February 22,
2023
Received in revised form:
February 14,
2023
Received:
December 22,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc.
