ORAL-DISEASE BURDEN IN PATIENTS UNDERGOING PROSTHETIC HEART-VALVE IMPLANTATION

Background. Valvular heart disease predisposing to endocarditis and re quiring prosthetic valve implantation is common among the elderly. Spo ntaneous bacteremias associated with acute or chronic oral/odontogenic infections may represent a far greater cumulative risk for the develo pment of endocarditis than do occasional health care procedures admini stered in a professional setting. Methods. To determine the oral disea se burden in patients undergoing mechanical or bioprosthetic heart val ve implantation, we performed a comprehensive clinical and radiographi c regional examination on 156 consecutive patients, with emphasis on i dentifying acute and chronic oral/odontogenic infections and condition s. Results. The mean number of remaining teeth in the cohort was 19.32 ; of these, 1.07 were carious, involving a mean number of 2.51 tooth s urfaces. In addition, 15.38% of the patients had evidence of acute or chronic periapical abscesses, and 43.6% of the patients had moderate t o advanced periodontitis. Conclusions. In view of the substantial morb idity and mortality associated with prosthetic valve endocarditis and based upon the high incidence of dental disease identified in patients undergoing valvular operations, routine preoperative dental assessmen t should be deemed a ''medical necessity'' by third-party payers. Appr opriate therapeutic intervention should be initiated whenever possible before valve implantation. (C) 1997 by The Society of Thoracic Surgeo ns.