Tooth Care for the Prosthetic Valve Patient

[The Thief]

Oops, I may have posted this twice... Just thought I would leave this here. I just wrote this blog post on the recommendations that my infectious disease doctor gave me after my battle with Infective Bacterial Endocarditis. These daily oral care instructions have been discussed here before, but I thought it would be helpful to post again. I also included a link to the 2007 AHA Endocarditis prevention guidelines, which loosened up a bit from the 1997 guidelines.

https://robovalve.wordpress.com/2016/02/02/tooth-care-for-the-prosthetic-valve-patient/

 

[Paleowoman]

That's really interesting Anthony ! I had to have a wisdom tooth extracted in hospital last year. In the theatre, where I had to put gown etc on, I asked the theatre staff why they didn't clean or sterilise my mouth before the extraction. They knew I had a bioprosthetic valve (was taking antibiotics). I was told that there are so many different strains of bacteria in the mouth that it's impossible to sterilise it. Since then, as part of my daily teeth/gum care routine, I now have a daily oral probiotic, that is not one for the gut but one specifically for the mouth, with bacteria which can have a beneficial effect on the health of the teeth and gums. There's still a lot of research going on with this.

PS - I also make sure I don't eat the kind of foods which encourage the bad bacteria to thrive.

 

[MethodAir]

Thanks for the recommendations, Anthony.

I have followed your blog since undergoing AVR myself last year. Is it possible your BE was caused by the sutures coming loose (thereby infecting the surgical area)? I have heard of another case of someone locally who also received an OnX aortic valve, and within months of surgery, discovered that the sutures were coming loose. This was due to surgical error (and not an issue with the mechanical valve itself).

My surgeon was adamant about using an OnX ascending prosthesis as he said the valve was 'better seated' this way.

 

[The Thief]

What happened in my case wa sthat the sutures that hold the valve in place got infected. The surrounding tissue was infected too. The infection occured before the sutures came loose. The sutures coming loose was caused by the infection. Bacteria ate the tissue in and around the sutures. My guess of how bacteria got into my bloodstream is from the initial surgery itself. Sometimes that just happens. I was having some gum bleeding some time after my surgery too, so it could have been that. Who knows!?

 

[tsanjose]

just read your blog. wow, that's crazy man. glad to hear you're all sorted now. i'm 3 mos out of mitral valve repair myself. i got to hand it to you, you're a champ. question about frequency... how often are you doing this? 3x a day or is 2x good enough?

Paleogirl, what types of food encourage bacteria to thrive? please don't say sushi/sashimi...

 

[MethodAir]

The infection occured before the sutures came loose. The sutures coming loose was caused by the infection.

How were you able to have this verified? In the case of surgical error, where the sutures come loose (as noted in another patient), I can only imagine that an exposed, relatively fresh wound could be a breeding ground for bacteria.

 

[Paleowoman]

Paleogirl[/USER], what types of food encourage bacteria to thrive? please don't say sushi/sashimi...

It's more like what types of foods you want to avoid which encourage the bad bacteria to thrive because if those bacteria are not thriving the beneficial types have more of a chance to thrive. Sugars are the most obvious ones, they encourage bad bacteria, but so do starchy carbs - in school there was an experiment you might have done in biology to eat a dry water biscuit and hold it in your mouth for a minute or so: it starts to taste sweet because the enzyme amylase in saliva breaks down the starches into sugars which feed the bad bacteria.

 

[carolinemc]

And for those who did not mention it here, you always need to premedicate before and after any dental proceedure, including teeth cleaning for encharditis. It is all in provention of infection that can go straight to the heart and cause complications. I have always premed and after since the first day in the dentist chair as a child.