Department of Special Care Dentistry, Matsumoto Dental University, Nagano, Japan.
Department of Special Care Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
BMC Oral Health. 2019 Aug 30;19(1):200. doi: 10.1186/s12903-019-0893-3.
Antibiotic prophylaxis before invasive treatments, including dental extractions, is still recommended for patients at high risk of infective endocarditis. However, the risk from self-extraction of teeth in daily life of patients with intellectual disabilities is uncertain.
A 6-year-old patient with Ebstein's anomaly developed cerebral abscess, which appeared associated with infective endocarditis of dental origin. Two weeks after self-extraction of his deciduous teeth, he began to experience pain in his ear and developed continuous fever, followed by vomiting, facial spasm, and a loss of consciousness. He was admitted into a hospital for 2 months, during which he received intravenously administered antibiotics and a drainage tube in his brain.
Deciduous teeth can be self-extracted before root resorption and natural shedding in patients with intellectual disabilities. When they are at high risk of infective endocarditis and frequently touch mobile deciduous teeth, it seems to be an option to extract the teeth early with antibiotic prophylaxis, rather than to wait natural fall.
对于感染性心内膜炎高危患者,在接受侵入性治疗(包括拔牙)前仍推荐使用抗生素预防。然而,智力障碍患者在日常生活中自行拔牙的风险尚不确定。
一名 6 岁患有 Ebstein 畸形的患者发生脑脓肿,该脓肿似乎与牙源性感染性心内膜炎有关。在自行拔除乳牙后两周,他开始出现耳部疼痛,并持续发热,随后出现呕吐、面部痉挛和意识丧失。他住院 2 个月,期间接受了静脉注射抗生素和脑内引流管治疗。
智力障碍患者的乳牙可能在牙根吸收和自然脱落之前自行脱落。当他们有感染性心内膜炎的高风险,并且经常触及松动的乳牙时,似乎可以选择在早期进行预防性拔牙,而不是等待其自然脱落。