Determining the Relationship of Bacteria Associated With Dental Disease and Infective Endocarditis

Abstract

Objectives Poor oral hygiene is a risk factor for bacteremia and infective endocarditis (IE). The purpose of this study was to determine the relationship of bacteria commonly associated with dental disease in native valve and prosthetic valve endocarditis patients at a tertiary center in Missouri. Methods This retrospective cross-sectional analysis reviewed the electronic medical records of patients diagnosed with definite IE, per the modified Duke criteria, at the University of Missouri Hospital between September 2015 and April 2019. Medical records were screened using International Classification of Diseases, Tenth Edition, code for IE (I 33) and further validated by screening echocardiography for intracardiac vegetations. Demographics, type of IE, echocardiographic findings, blood culture results, and relevant medical and dental data were recorded, and a descriptive analysis performed. Results One hundred twenty-seven patients with 134 episodes (mean = 51.1 years, SD ± 17.7 yrs; M: F = 1:1) satisfied the criteria. Of these, 19 (14.2%) episodes were identified to have blood culture results positive for bacteria associated with the oral cavity. Seventy-seven (57.5%) episodes were related to Staphylococcus aureus. Staphylococcus aureus is a constituent of normal oral flora and can contribute to oral disease and IE, but the connection between the 2 remains contentious in both medical and dental practice. Remarkably, 72 (53.8%) medical records lacked documentation of dental history and oral examination. Conclusions A significant proportion of IE cases are from bacteria associated with the oral cavity, advocating for routine dental evaluation and treatment as an essential component of care of patients with IE.