Periodontal treatment can be dangerous for the heart
Dental surgery can become a risk for patients with heart problems. Therefore cardiac patients should present their cardiological examination pass to the dentist before treatment. Endocarditis prophylaxis with antibiotics is often recommended in order to rule out the desired consequences for the heart.
New guidelines for dentists do not protect patients from heart disease The German Cardiological Society has written special guidelines for dentists so that cardiac patients do not face any health risks with dental treatments. Cornelia Piper, cardiologist and scientist at the Heart and Diabetes Center NRW (HDZ NRW), has now conducted a study to determine whether and to what extent the new guidelines are effective. The unsatisfactory result for cardiac patients: “High-risk patients are still well advised before dental treatment if they present their cardiological examination card. The new guidelines of the German Cardiological Society have so far not contributed to increasing the mindfulness of dentists, particularly with regard to preventive care for a life-threatening inflammatory heart disease (endocarditis), ”says the latest press release from the HDZ NRW.
Endocarditis is what doctors mean by inflammation of the inner lining of the heart. This covers the heart valves and lines the heart sockets as well as the arteries and veins near the heart. If the blood flow in the heart is changed due to illness, small injuries can repeatedly occur in the same places on the inner skin of the heart due to turbulence. If bacteria get into the blood, these areas are particularly susceptible to inflammation. Endocarditis is usually treatable with antibiotics. However, if no therapy is given, the disease leads to the death of the person concerned. People with congenital or acquired heart defects are particularly at risk, especially after replacing the heart valves.
"Periodontal treatment can be extremely dangerous for these high-risk patients," explains Piper. “So-called gram-positive bacteria from the gum pockets can get into the bloodstream as a result of numerous dental interventions. The bacteria then preferentially attach themselves to the heart valves and multiply. The result is endocarditis. ” According to the guidelines of the German Society for Cardiology, high-risk patients should undergo antibiotic therapy prior to dental treatment for endocarditis prophylaxis. “Taken an hour before the periodontal treatment, the antibiotic means that the bacteria can only colonize the heart valves in small amounts. This significantly reduces the risk of inflammation of the inner lining of the heart, ”reports the doctor.
Danger to the heart is reduced by antibiotic therapy Until 2007, before the new guidelines came into force, antibiotic prophylaxis had been prescribed even for patients with a lower risk. According to Piper's study, patients were better advised at the time. "The child was poured out with the bath, so to speak," reports the doctor. The dentists would now carry out significantly fewer antibiotic therapies even for high-risk patients.
Already in 2003, Piper showed in an earlier study that the guidelines regarding dental treatments pose problems in practice. "It has been shown that the safest way for our patients is the so-called patient ID card, which should be presented to the treating doctor with the appropriate guidelines," reports Piper. “There is also a question of whether antibiotic prophylaxis should not also be recommended for patients with a so-called moderate risk of endocarditis. Reliable data is still missing here. ” (ag)
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