The endocarditis patient with active caries lesions*

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 thethe 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.