Oral hygiene and infective endocarditis: a case control study

Objective

To determine if oral hygiene is associated with infective endocarditis (IE) among those at moderate risk for IE.

Study Design

This is a case control study of oral hygiene among hospitalized patients with IE (cases) and outpatients with heart valve disease but without IE (controls). The primary outcome was mean dental calculus index. Secondary outcomes included other measures of oral hygiene and periodontal disease (e.g., dental plaque, gingivitis) and categorization of blood culture bacterial species.

Results

The 62 case participants had 53% greater mean dental calculus index than the 119 control participants (0.84, 0.55, respectively; difference = 0.29, 95% CI:0.11, 0.48; p=0.002) and 26% greater mean dental plaque index (0.88, 0.70, respectively; difference = 0.18, 95% CI: 0.01,0.36; p=0.043). Overall, cases reported fewer dentist and dental hygiene visits (p= 0.013) and fewer dental visits in the 12 weeks prior to enrollment than controls (p=0.007). Common oral bacteria were identified from blood cultures in 27 of 62 cases (44%).

Conclusions

These data provide evidence to support and strengthen current AHA guidance that those at risk for IE can reduce potential sources of IE-related bacteremia by maintaining optimal oral health through regular professional dental care and oral hygiene procedures.