Odontogenic Infection Sources in Patients Scheduled for Cardiac Valve Replacement

Purpose: Odontogenic infection sources represent a predisposing risk factor for patients with cardiac valvular disease (CVD) awaiting cardiac valve replacement procedures. Study design: The incidence and quality of odontogenic infection sources (foci) were evaluated on 152 consecutive patients (study group, SG) undergoing cardiac valve replacement and were compared to 150 age-, gender- and residence-matched noncardiac patients (control group, CG). Clinical and radiographic examinations were used to evaluate the incidence of odontogenic infection sources, grouped into potential (high risk) and facultative foci (possible risk), and the presence/severity of periodontal disease (PD). Foci and PD were compared among the overall SG and the CG and also among a sophisticated subdivision of the study group, especially with respect to aortic valve (AVR) and mitral valve replacement (MVR). Results: Overall, 218 potential and 116 facultative odontogenic foci were found in 87 (58.3%) and in 79 (51.9%) patients of the SG respectively. The overall incidence of odontogenic infection sources and the incidence and severity of PD did not differ between the SG and the CG. However, in comparison with the CG (48%), the incidence of potential odontogenic infection foci was significantly higher in patients scheduled for AVR than in those scheduled to undergo MVR (70.4% vs. 25.0%, p0.01). Additionally, in patients scheduled for AVR, a significantly higher number (p0.01) of individual potential dentogenic infection foci (1.7 vs. 0.8 foci/valve) and a higher prevalence of PD (60.2%) was seen than for patients scheduled for MVR (31.8%) or for patients without CVD (1.0 foci/valve; 39.3%; p0.05). Discussion: Although the overall incidence of odontogenic infection sources did not differ between the patients with and without CVD, a sophisticated subdivison of CVD may be crucial, demonstrating that patients with AVR differ significantly from those with MVR and with the healthy CG. Cardiologists and cardiac surgeons play an important role in organising oral rehabilitation of patients scheduled for valve replacement. Keywords: cardiac valve surgery, dentogenic infection foci, focus treatment, oral rehabilitation