Avoiding infective endocarditis

Infective endocarditis can be caused by bacteria from the mouth, and other parts of the body. If you are having heart valve surgery, or surgery to repair a structural heart defect, you will have an increased risk of infective endocarditis.

Your heart team will request a dental assessment before your surgery. This is to make your mouth as healthy as possible, to reduce your risk of getting infective endocarditis from oral bacteria.

Depending on your health status and access to dental care, this might be done by your own dentist or you might be referred to a clinic at Guy’s or St Thomas’ hospitals. If your surgery is urgent and cannot wait, the assessment might be requested after your surgery instead.

If you already have infective endocarditis, a dental assessment might be requested to check if your mouth is a source of infection.

Dental assessment

We do a full dental assessment to check for gum and dental diseases that may increase your risk of infective endocarditis. We will give advice, and arrange for you to have treatments that are a priority, if needed.

Remaining a dental patient at Guy’s Hospital

Unless you need specific treatment in a hospital setting, we cannot provide long-term dental care. You should register with a local dentist to make sure you have regular dental checks. 

Good oral hygiene

To try and prevent getting infective endocarditis in the future, you should make sure that you follow a good oral hygiene routine.

You should visit your dentist regularly, usually every 6 months, to make sure the earliest signs of tooth or gum disease are treated. Your dental team will help you to look after your teeth, dental implants, and gums. It is important to follow their advice to reduce the risk of infective endocarditis.

Always get abscesses or gum disease treated.

 

Always tell your dentist about your cardiac condition, and what medicines you are taking.

Every person is different, so treatment can be personalised. Your dentist might recommend specialist periodontal (gum) care, involving:

• regular cleanings
• periodontal evaluation
• supportive periodontal care

Specific dental treatments (such as scaling, extractions, or oral surgery) might increase the risk of bacteria entering the bloodstream and causing infective endocarditis. Some cases of infective endocarditis occur because of daily activities such as toothbrushing, flossing, and chewing, particularly if you have poor oral hygiene. Maintaining excellent oral health and hygiene is essential to help prevent infective endocarditis.

Good oral health can be helped by:

• being aware of the connection between oral health and heart health
• having regular dental check-ups with your local dentist to treat any issues early
• regularly checking your mouth for signs of gum disease, such as redness, swelling, bleeding or receding gums, and wobbly teeth or implants. If you notice any of these signs, please see your dentist as soon as possible.

Dental plaque control can usually be achieved by:

• toothbrushing. Use an electric toothbrush if possible. Use a toothpaste that contains fluoride. Brush at least 2 times each day for at least 2 minutes, making sure you reach all surfaces of your teeth.
• using disclosing plaque tablets. These show any plaque on your teeth. They can help you check that you are cleaning your teeth well. Please note that the staining is temporary and will fade after thorough brushing. Do not swallow the tablets. We recommend using the disclosing tablets under the guidance of a dental professional, especially for the first time.
• interdental brushing. Toothbrushing should be supplemented by using interdental brushes every day.
• flossing. Floss every day to remove food particles and plaque between your teeth, and along the gumline. Flossing can help stop tooth decay and cavities (holes that need fillings).
• cleaning your tongue. This can help to remove harmful bacteria, and reduce bad breath.
• using a mouthwash. Your dentist might suggest you use a mouthwash (antiseptic rinse) for a limited time. 
• 'flossing' with water. A water flosser uses a pressurised stream of water to clean between teeth. This tool can be useful for some people, but should not be used instead of interdental brushes.
• dental check ups. Visit the dentist every 6 months.

Antibiotics before invasive dental treatments

You should discuss with your cardiologist if you should have antibiotics before invasive dental procedures (such as extractions, scaling, or procedures that involve manipulating or cutting the gums). If antibiotic are needed, you will usually be given amoxicillin 1 hour before your dental treatment. If you are allergic to penicillin, the recommended alternative is clindamycin.

If you think you are allergic to penicillin, consider asking your GP to refer you to an allergy specialist for testing. Only 1 in 10 people who think they are allergic to penicillin are actually allergic.

You should have been issued with an endocarditis alert card. The card explains the antibiotics you need to take. You should show this to your doctor, dentist or healthcare professional before you have any treatment (especially dental).

Taking care of your skin

You should avoid any cosmetic procedures that involve breaking the skin, such as body piercing or tattooing.

Other ways to reduce the risk of infective endocarditis

• Stopping smoking. Smoking is a significant risk factor for gum disease and heart disease.
• Limiting alcohol. Having too much alcohol can make your oral, and overall, health worse.
• Controlling your diabetes. You should follow recommendations from your medical team.
• Lifestyle and diet. There is a possible link between physical activity, stress management, and dietary habits on your gum health.
• Limiting your sugar intake. Reduce how much sugary or acidic snacks and drinks you have, as they can increase tooth decay and gum disease.
• Keeping hydrated. Some medicines cause a dry mouth, which increases the risk of tooth decay.
• Washing with soap and water. This will clean bacteria from your skin.