Faculty of Dentistry,1 place Alexis Ricordeau 44042 Nantes, France
Med Oral Patol Oral Cir Bucal. 2022 Jan 1;27(1):e42-e50. doi: 10.4317/medoral.24885.
Infective endocarditis (IE) is a rare and life-threatening disease. Cutaneous portal of entry (POE) is predominant for IE, but an oral POE is the second most frequent source. Thus looking for and treating an oral POE in IE patients is of critical importance in order to reduce the risk of IE relapse or recurrence. The objectives of this study were: 1) To reach a consensus on decision-making following the detection of an oral POE on cone-beam computed tomography (CBCT) while they were not identified using the current recommended approach in IE patients (oral examination and orthopantomogram: OPT). 2) To determine whether this consensus differs when regarding the microbiology of IE.
Twenty oral or maxillofacial surgeons participated to this Delphi study. The questionnaire was based on five radiological cases (OPT and matching CBCT) with two scenarios according to the objectives of detecting oral POE in an IE patient (curative in case of oral causative microorganism, and preventive if not) and different therapeutic approaches (surgical or conservative treatment, no treatment) for each of them. Consensus was defined as an agreement rate of ≥75%.
The response rate was≥85%. After four rounds, consensus was achieved for all proposals. CBCT changed the decision-making of experts in four cases. In one case, the decision was influenced by the IE microbiology toward a more radical approach in case of oral causative microorganism.
In IE patients, CBCT changed markedly the decision-making of experts by eradicating more oral POE than when using OPT. This could reduce the risk of IE relapse and recurrence.
感染性心内膜炎（IE）是一种罕见且危及生命的疾病。皮肤入口（POE）是 IE 的主要入口，但口腔 POE 是第二常见的来源。因此，在 IE 患者中寻找和治疗口腔 POE 对于降低 IE 复发或再发的风险至关重要。本研究的目的是：1）在当前 IE 患者（口腔检查和全景片：OPT）未识别到口腔 POE 时，就 CBCT 检测到口腔 POE 后做出决策达成共识。2）确定在 IE 的微生物学方面是否存在差异。
20 名口腔颌面外科医生参与了这项德尔菲研究。该问卷基于五个影像学病例（OPT 和匹配的 CBCT），根据在 IE 患者中检测口腔 POE 的目的（如果存在口腔致病微生物，则为治愈性，如果不存在，则为预防性）和每种情况下不同的治疗方法（手术或保守治疗，不治疗）有两个场景。共识定义为≥75%的同意率。
响应率≥85%。经过四轮，所有建议均达成共识。在四种情况下，CBCT 改变了专家的决策。在一种情况下，IE 微生物学影响了决策，对于口腔致病微生物，采用更激进的方法。
在 IE 患者中，CBCT 通过消除比 OPT 更多的口腔 POE，显著改变了专家的决策。这可以降低 IE 复发和再发的风险。
