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Arch Cardiovasc Dis. 2017 Aug - Sep;110(8-9):482-494. doi: 10.1016/j.acvd.2017.01.012. Epub 2017 Jun 16.

Position paper for the evaluation and management of oral status in patients with valvular disease: Groupe de Travail Valvulopathies de la Société Française de Cardiologie, Société Française de Chirurgie Orale, Société Française de Parodontologie et d'Implantologie Orale, Société Française d'Endodontie et Société de Pathologie Infectieuse de Langue Française.

Author information

1
Department of oral surgery, Montpellier university hospital, 34295 Montpellier, France; Inserm 1149, 75018 Paris, France.
2
Department of oral surgery, Nantes hospital, university of Nantes, Inserm U791, LIOAD, 44093 Nantes, France.
3
Department of periodontology, Louis-Mourier hospital, AP-HP, university of Paris Descartes, 92700 Colombes, France.
4
Department of oral surgery, Louis-Mourier hospital, AP-HP, university of Paris Descartes, Inserm U1018, 92700 Colombes, France.
5
Odontology department, Bichat hospital, AP-HP, 75018 Paris, France.
6
Department of oral surgery, Pitié-Salpétrière hospital, AP-HP, university of Paris Descartes, 75013 Paris, France.
7
Department of oral surgery, Bretonneau hospital, AP-HP, university of Paris Descartes, 75018 Paris, France.
8
Department of implantology and prosthetics, Pitié Salpétrière hospital, AP-HP, university of Paris Descartes, 75013 Paris, France.
9
Endodontics department, Pitié-Salpétrière hospital, AP-HP, Paris-Diderot university, 75013 Paris, France.
10
Department of cardiology, Georges Pompidou european hospital, AP-HP, institut mutualiste Montsouris, 75014 Paris, France.
11
Department of thoracic and cardiovascular surgery, Rouen university hospital, Inserm U1096, 76000 Rouen, France.
12
Department of cardiac surgery, institut mutualiste Montsouris, 75014 Paris, France.
13
Department of cardiology, university hospital of Amiens, Inserm U1088, Jules-Verne university of Picardie, 80480 Amiens, France.
14
Department of cardiology, La Timone hospital, Aix-Marseille university, 13385 Marseille, France.
15
Centre of clinical investigations, Inserm 1425, Bichat hospital, AP-HP, Paris-Diderot university, Inserm U1137, AEPEI, 75018 Paris, France.
16
Department of cardiology, Bichat hospital, AP-HP, DHU FIRE, Paris-Diderot university, 46, rue Henri-Huchard, 75018 Paris, France. Electronic address: bernard.iung@aphp.fr.

Abstract

Oral health is of particular importance in patients with heart valve diseases because of the risk of infective endocarditis. Recommendations for antibiotic prophylaxis before dental procedures have been restricted, but the modalities of oral evaluation and dental care are not detailed in guidelines. Therefore, a multidisciplinary working group reviewed the literature to propose detailed approaches for the evaluation and management of buccodental status in patients with valvular disease. Simple questions asked by a non-dental specialist may draw attention to buccodental diseases. Besides clinical examination, recent imaging techniques are highly sensitive for the detection of inflammatory bone destruction directly related to oral or dental infection foci. The management of buccodental disease before cardiac valvular surgery should be adapted to the timing of the intervention. Simple therapeutic principles can be applied even before urgent intervention. Restorative dentistry and endodontic and periodontal therapy can be performed before elective valvular intervention and during the follow-up of patients at high risk of endocarditis. The detection and treatment of buccodental foci of infection should follow specific rules in patients who present with acute endocarditis. Implant placement is no longer contraindicated in patients at intermediate risk of endocarditis, and can also be performed in selected high-risk patients. The decision for implant placement should follow an analysis of general and local factors increasing the risk of implant failure. The surgical and prosthetic procedures should be performed in optimal safety conditions. It is therefore now possible to safely decrease the number of contraindicated dental procedures in patients at risk of endocarditis.

KEYWORDS:

Dental implant; Endocardite infectieuse; Foyers infectieux oraux; Implant dentaire; Infective endocarditis; Oral infectious foci; Parodontopathie; Periodontitis; Valvular heart disease; Valvulopathie

PMID:
28629781
DOI:
10.1016/j.acvd.2017.01.012
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