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Oral hygiene to prevent heart infection from mouth bacteria

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Maintaining good oral health is more important than the use of antibiotics in dental procedures, according to a new American Heart Association (AHA) scientific statement.

Oral hygiene may be key in preventing a heart infection caused by bacteria around the teeth, affirmed the statement, published in the journal Circulation.

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Infective endocarditis (IE), also called bacterial endocarditis, is a heart infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve, or a blood vessel.

Intravenous drug use increases risk for IE. There’s been concern that certain dental procedures may increase the risk of developing Viridans group streptococcal infective endocarditis (VGS IE) in vulnerable patients.

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VGS IE is caused by bacteria that collect in plaque on the tooth surface and cause inflammation and swelling of the gums.

“Scientific data since the 2007 AHA guidelines support the view that limited use of preventive antibiotics for dental procedures hasn’t increased cases of endocarditis and is an important step at combating antibiotic overuse in the population,” said Walter R. Wilson, from the Department of Internal Medicine at Mayo Clinic in Rochester, Minnesota, US.

The new guidance affirms previous recommendations that only four categories of heart patients should be prescribed antibiotics prior to certain dental procedures to prevent VGS IE due to their higher risk for complications from the infection. The groups are: people with prosthetic heart valves or prosthetic material used for valve repair; people who have had a previous case of infective endocarditis; adults and children with congenital heart disease; or people who have undergone a heart transplant.

The AHA’s 2007 guidelines, which presented the biggest shift in recommendations, resulted in about 90 per cent fewer patients requiring antibiotics.

Prescribing antibiotics prior to certain dental procedures only among high risk patients may help prevent VGS IE, the researchers noted.

In the presence of poor oral hygiene and gingival disease, VGS IE is far more likely to develop from bacteria attributable to routine daily activities such as toothbrushing than from a dental procedure, they said.

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