Most cases of procedure-related endocarditis occur within 10 to 14 days of the procedure. Therefore, if you present with any symptoms beyond this time, it is doubtful that you have endocarditis.

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Endocarditis is the result of a bacterial infection. It is a rare and life-threatening condition that involves inflammation of the heart muscle lining and valves. While endocarditis can occur in anyone, it is more common in people with heart conditions and people who have experienced endocarditis in the past.

Symptoms of Endocarditis

Possible symptoms of endocarditis include:

1) Unexplained fever

2) Night chills

3) Weakness, muscle pain, or joint pain

4) Sluggishness (lethargy) or malaise (general ill feeling)

While antibiotic administration lowers the risk of endocarditis, it does not guarantee prevention. Most cases of procedure-related endocarditis occur within 10 to 14 days of the procedure. Therefore, if you present with any symptoms beyond this time, it is very unlikely that you have endocarditis. Regardless, it is always wise to consult with your doctor or dentist if you harbour any concerns.

Endocarditis Prevention Guidelines

The American Heart Association Endocarditis Committee issued a set of guidelines initially in 1997 and then in 2007 to help prevent endocarditis. After reviewing multiple studies, the committee concluded that only a rare number of cases of infective endocarditis might be prevented by administering antibiotics before dental procedures. For patients with heart disease and thus at high risk of developing complications due to endocarditis, antibiotic treatment before dental procedures involving gum manipulation is a reasonable preventive measure.

In rare cases involving high-risk individuals, bacteria present in the mouth may trigger endocarditis. Plaque found in tooth plaque may cause gingivitis, i.e., gum inflammation. If left untreated, gingivitis may advance and cause gums to become red, swollen, and bleed during brushing, flossing, or any dental procedures involving gum manipulation. When gums bleed, it gives way for bacteria to enter the bloodstream and infect other body parts. In the case of endocarditis, it is the inner lining of the heart and the surfaces of its valves.

Since this occurrence is so rare, the latest guidelines by the AHA suggest administering antibiotics before dental procedures only for patients at the highest risk of developing complications from endocarditis. The reason for doing so is that in most cases, the risk associated with antibiotic use i.e., formation of blood clots, surpasses its prophylactic use benefits.

Who should receive antibiotics before dental treatment?

Patients with certain heart conditions are advised to receive a single dose of an antibiotic at least an hour before specific dental procedures as a prophylactic measure. As per the American Heart Association and the American Dental Association, antibiotics must be administered before dental treatment to patients with:

1) History of bacterial endocarditis

2) A prosthetic cardiac valve or prosthetic material used in valve repair

3) Cardiac valve disease and have had a cardiac transplant

4) Congenital heart disease

Dental procedures in which antibiotics are recommended

The new guidelines suggest preventive treatment before the following dental procedures.

1) Dental procedures with gingival tissue manipulation

2) A perforated inside lining of the mouth

However, antibiotics are not recommended for the following dental procedures:

1) Routine anaesthetic injections through noninfected tissue

2) Dental X-rays

3) Adjustment of orthodontic appliances

4) Placement of removable prosthodontic or orthodontic appliances

5) Placement of orthodontic brackets

6) Bleeding from trauma to the inside of the mouth or lips

7) Shedding of baby teeth

Lower the risk of acquiring bacterial endocarditis

If you notice your health change since your last visit, you must inform your dentist. Make sure to provide a detailed account of your medical history, especially if you have a history of heart or vascular surgery in the past six months and the diagnosis of any other heart condition. You should provide them with a list of all your medications and dosages, prescription and over-the-counter. Provide your dentist with your physician's contact number if they wish to correspond with them regarding your dental care plan and choice of medications. Practice good oral hygiene by brushing your teeth twice, flossing at least once, and regularly using an antiseptic mouth wash. Good oral health is integral for patients at a high risk of endocarditis.