The endocarditis patient with active caries lesions*
The patient is 39 years old and has previously undergone aortic valve replacement due to valve failure and endocarditis. ASS 100 is taken regularly as an anticoagulant. In terms of lifestyle, the patient’s diet is classified as caries-promoting due to the regular consumption of sugary foods and the fact that six to seven meals are consumed daily. The patient’s oral health indicates a moderate risk of caries, with active lesions. The risk of periodontitis is low, but gingivitis is present. The following recommendations are made for prophylactic treatment.
The heart valve replacement and the history of endocarditis indicate an increased risk of complications. In order to reduce the risk of inflammation recurring, antibiotic prophylaxis is recommended (e.g. 2 g amoxicillin, 1 hour before the session). Despite the long-term blood-thinning medication, it is not expected that there will be an increased risk of bleeding in the prophylactic session.
Enough time must be allowed for the instructive/ motivational discussion. The negative impact of nutritional behaviour on oral health (9) should be clearly conveyed to the patient. With regard to the history of endocarditis, the connections between cariogenic bacteria and cardiovascular disease may also be discussed (12). This can strengthen the patient’s motivation to make a sustainable change to their diet. The discussion should convey to the patient the importance of – and motivate them to practise – good oral hygiene at home.
No specific instrument recommendations can be determined for the prophylaxis session. Targeted application of air and rotary polishing can be used to gently reduce plaque and stains on the restoration edges, and to reduce recolonization niches for cariogenic bacteria (19).
Fluoridation is recommended to further support the prevention of caries, and especially to prevent new formation around the restoration edges, and to seal the root surfaces. Both of these measures can reduce the teeth’s sensitivity to temperature.
Due to the active caries lesions and the associated risk of progression, a shortened recall interval of three to four months is recommended.
* with the kind permission of Dr G. Schmalz and Dr D. Ziebolz MSc.
Individual Prophy Cycle – The patient-oriented prevention concept
Priv-Doz Dr Gerhard Schmalz is a senior physician at the Oral Health Medicine, Polyclinic for Dental Preservation and Periodontology, University Hospital Leipzig, Leipzig (Director: Prof Dr Rainer Haak).
Prof Dr Dirk Ziebolz MSc is a senior physician at the Polyclinic for Dental Preservation and Periodontology, Leipzig University Medical Centre (Director: Prof Dr R. Haak); with focus on interdisciplinary dental preservation and health services research.
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