Recent infective endocarditis research findings suggest dentists prescribe prophylactic antibiotics for patients having a bicuspid aortic valve or mitral valve prolapse.

BACKGROUND: The scientific validity of the European Society of Cardiology's (ESC) infective endocarditis (IE) guidelines limiting provision of prophylactic antibiotics (AP) only to patients having cardiac anomalies (e.g., prosthetic valves) believed to place them at "high risk" of adverse events when undergoing high risk dental procedures (HRDP) is unclear. MATERIAL AND METHODS: A systematic review of studies conducted between 2017 and 2022 and catalogued in the PubMed database was undertaken to ascertain if this edict was associated with changes in IE incidence, development of infection in unprotected cardiac anomalies, developing infection and resultant adverse clinical outcomes. RESULTS: Retrieved were 19 published manuscripts, however of these, 16 were excluded because they did not bare upon the issues of concern. Among the three studies eligible for review were those in the Netherlands, Spain, and England. The results of the Dutch study denoted a significant increase in the incidence of IE cases over the projected historical trend (rate ratio: 1327, 95% CI 1.205-1.462; p<0.001) after the introduction of the ESC guidelines. The findings from the Spanish study evidenced the uniquely high in-hospital IE associated fatality rates suffered by patients having bicuspid aortic valves (BAV); 5.6% or mitral valve prolapse (MVP); 10%. The British study provided evidence that the incidence of fatal IE infection was significantly greater among an "intermediate risk" cohort of patients, (a group likely including those with BAC and MVP for which the ESC guidelines don't recommend AP), than among "high risk" patients (P = 0.002). CONCLUSIONS: Patients having either a BAV or MVP are at significant risk of developing IE and suffering serious sequelae including death. The ESC guidelines must reclassify these specific cardiac anomalies into the "high risk" category so that AP are recognized as being needed prior to provision of HRDP.

Una nueva responsabilidad para los odontólogos en el tratamiento del paciente irradiado / a new responsability for dentist managing the irradiated patient

Los tumores malignos del tracto superior respiratorio y digestivo son frecuentes en España. Los pacientes que padecen estas enfermedades oncológicas, frecuentemente, reciben radioterapia en la boca, cara y cuello para su tratamiento. Clásicamente, los odontólogos han participado en el cuidado de estos pacientes para identificar las recidivas o nuevas lesiones de cáncer y prevenir las caries rampantes y la patología periodontal florida asociada a la xerostomía provocada por el deterioro postirradiación de las glándulas salivales. Además la radioterapi también lesiona la arteria carótida cervical acelerando el proceso de arterioesclerosis. Los odontólogos deben examinar, detenidamente, las radiografías panorámicas de estos pacientes para evidenciar la existencia de ateromas calcificados carotídeos que pueden provocar un desenlace fatal o un accidente cerebrovascular incapacitante (AU)