Millot Sarah, Lesclous Philippe, Colombier Marie-Laure, Radoi Loredana, Messeca Clément, Ballanger Mathieu, Charrier Jean-Luc, Tramba Philippe, Simon Stéphane, Berrebi Alain, Doguet Fabien, Lansac Emmanuel, Tribouilloy Christophe, Habib Gilbert, Duval Xavier, Iung Bernard
Department of oral surgery, Montpellier university hospital, 34295 Montpellier, France; Inserm 1149, 75018 Paris, France.
Department of oral surgery, Nantes hospital, university of Nantes, Inserm U791, LIOAD, 44093 Nantes, France.
Arch Cardiovasc Dis. 2017 Aug-Sep;110(8-9):482-494. doi: 10.1016/j.acvd.2017.01.012. Epub 2017 Jun 16.
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.
由于存在感染性心内膜炎的风险，口腔健康在心脏瓣膜病患者中尤为重要。牙科手术前抗生素预防的建议已受到限制，但口腔评估和牙科护理的方式在指南中并未详细说明。因此，一个多学科工作小组查阅了文献，以提出评估和管理瓣膜病患者口腔牙齿状况的详细方法。非牙科专科医生提出的简单问题可能会引起对口腔牙齿疾病的关注。除了临床检查外，最近的成像技术对检测与口腔或牙齿感染灶直接相关的炎性骨破坏高度敏感。心脏瓣膜手术前口腔牙齿疾病的管理应根据干预时机进行调整。即使在紧急干预之前也可应用简单的治疗原则。修复牙科、牙髓病和牙周治疗可在择期瓣膜干预之前以及在心内膜炎高危患者的随访期间进行。对于患有急性心内膜炎的患者，口腔牙齿感染灶的检测和治疗应遵循特定规则。在心内膜炎中度风险患者中，种植体植入不再被视为禁忌，在选定的高风险患者中也可进行。种植体植入的决定应在分析增加种植体失败风险的全身和局部因素后做出。手术和修复程序应在最佳安全条件下进行。因此，现在有可能安全地减少心内膜炎风险患者中禁忌牙科手术的数量。
