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Oral hygiene as a risk factor in infective endocarditis

From Volume 44, Issue 9, October 2017 | Pages 877-890

Authors

Jennifer A Haworth

PhD

Academic Clinical Lecturer, Bristol Dental School, University of Bristol, Lower Maudlin Street, BS1 2LY, Bristol, UK

Articles by Jennifer A Haworth

Richard G Mears

BDS

General Dental Practitioner, Combe Road Dental Practice, 6 Combe Road, Portishead, BS20 6BJ and Clinical Teaching Fellow, Restorative Dentistry, Bristol Dental School, University of Bristol, Lower Maudlin Street, BS1 2LY, Bristol, UK

Articles by Richard G Mears

Howard F Jenkinson

PhD

Professor of Oral Microbiology, Bristol Dental School, University of Bristol, Lower Maudlin Street, BS1 2LY, Bristol, UK

Articles by Howard F Jenkinson

Steve W Kerrigan

PhD

Senior Lecturer in Pharmacology, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland

Articles by Steve W Kerrigan

Angela H Nobbs

PhD

Senior Lecturer in Oral Microbiology, Bristol Dental School, University of Bristol, Lower Maudlin Street, BS1 2LY, Bristol, UK

Articles by Angela H Nobbs

Abstract

There are many known associations between oral and systemic diseases. This review paper summarizes the proposed mechanisms underlying the links between dental disease and cardiovascular disease before introducing recent research regarding bacteria-platelet interactions. New protein factors have been identified on dental plaque bacteria. One of these, PadA, triggers blood to clot. This research provides new information about how Streptococcus bacteria and platelets interact and could lead to the development of new ways to control the formation of blood clots caused by micro-organisms that access the bloodstream.

CPD/Clinical Relevance: This article aims to provide the whole dental team with an overview of bacteria-platelet interactions. This is of particular relevance to infective endocarditis and the recent change in wording to the NICE antibiotic prophylaxis guidelines in the UK.

Article

The mouth is often referred to as a window into the health of the body, but the idea of oral diseases being a risk factor for systemic diseases is not a new concept. The importance of oral hygiene was noted by the Ancient Greeks1 and Hippocrates recorded two cases where eradication of mouth infections relieved patients of rheumatic joint problems.2 The British surgeon, William Hunter, is regarded as one of the first in the 20th century to emphasize the role of oral sepsis in leading to generalized diseases3 and removal of infected teeth was common. In contrast, the second half of the 20th century saw increased conservation and restoration of teeth, with relatively little published about possible links between oral and systemic diseases. However, a seminal study in 1989 reported that dental health was significantly worse in patients with acute myocardial infarction, after adjusting for risk factors.4 Subsequent papers re-ignited the debate and the turn of the 21st century saw a renewed scientific interest in the links between oral and systemic diseases, with increasing awareness that the mouth can act as a reservoir for pathogenic bacteria and their products.

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