Infective endocarditis is a rare but life-threatening infection in the heart lining or heart valves. For decades, the infection has been linked to dental procedures, which can allow bacteria in the mouth to enter the bloodstream. But medical experts have struggled to control the problem. New guidelines from the American Dental Association provide concrete steps for action.
Though any patient could, in theory, develop a bacterial infection, some people live at a significantly increased risk. Dentists are responsible for identifying these patients, many of whom have received heart valve implants or undergone treatment for congenital heart defects.
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After recognizing who is at risk, medical professionals are asked to prescribe a prophylactic regimen of antibiotics in anticipation of certain procedures. For many people, these antibiotics are a life-saver, but other patients aren’t so lucky. When dentists fail to follow current medical standards, vulnerable patients can quickly develop a virulent infection.
Dental offices are often segregated from the records kept by other physicians, a fact that prevents the seamless communication of medical records. Even worse, some dental offices fail to complete a thorough patient intake. That leaves medical professionals without an accurate understanding of a patient’s medical history that would identify risk factors.
As a result, some dentists are left unaware that their patient, scheduled for surgery or tooth extraction, is living with a prosthetic device and should be considered at-risk for developing a bacterial infection in the heart known as endocarditis. As the American Heart Association and American Dental Association advise, patients who live at risk of contracting endocarditis should receive antibiotics before their procedure. In some cases, a dentist’s failure even rises to the level of medical negligence.
Recent reports suggest that some dentists aren’t following these industry-standard guidelines. A 2016 investigation by the New Jersey Department of Health linked a single dentist, Dr. John Vecchione, to at least 15 cases of infective endocarditis, the Daily Record reports. Twelve of the dentist’s patients were forced to undergo heart surgery. One of these people died.
The attorneys at Banville Law believe dental malpractice may be widespread. As we open a full investigation into cases of bacterial endocarditis linked to dentistry, our experienced medical malpractice lawyers have begun offering free consultations to patients and families affected by inadequate dental care.
If you or a loved one developed a heart infection after undergoing a dental operation, contact our attorneys to learn more about your legal options. Some families may be entitled to secure significant financial compensation.
While infective endocarditis is a life-threatening disease, antibiotics come with their own risks. Over time, medical authorities have been forced to strike a balance between these competing interests.
While antibiotics should be prescribed to people who already live at an increased risk for bacterial endocarditis, health experts agree that no one should be unnecessarily exposed to the additional risks of antibiotics. That’s especially true today, when the over-administration of antibiotics has led to stronger and more virulent forms of bacteria.
Most cases of bacterial endocarditis trace back to S viridans, a family of the common bacteria known as streptococcus. The majority of successful malpractice lawsuits also come down to evidence of Streptococcus. As researchers from the University of Liverpool found in a 2007 study for the British Dental Journal, out of 83 successful plaintiff suits under review, 80 were buttressed by an isolated sample of Streptococcus taken from the injured patient’s mouth.
The average human mouth is home to between 34 and 72 different types of bacteria, Colgate reports. Streptococcus mutans is particularly common, and a primary contributor to tooth decay. A member of the S viridans family, Streptococcus mutans is the main cause of dental damage.
As the bacteria consumes sugars and starches (“stolen” from the food that we eat), it produces lactic acid as a by-product. And by making the oral environment more acidic, S mutans contributes directly to the breakdown of enamel that drives so many patients into the dentist’s office.
The bacteria is even more of a problem, however, when it’s allowed to enter a patient’s bloodstream. Left untreated, a bacterial colony on the teeth can multiply out of control, ultimately infecting the gum tissue. The resulting disease, called gingivitis, leads to extremely-unpleasant side effects. The gums can became inflamed, red and swollen. Bleeding is the real problem, though.
Common after brushing, flossing or certain dental surgeries, bleeding in the gums or mouth lining opens a pathway between the oral cavity (along with the bacteria found there) and the patient’s bloodstream. Bacteria can infiltrate this new conduit, spreading along with the flow of blood and reaching internal organs.
Endocarditis is quite possibly the most serious complication. This form of infection occurs when the bacteria are able to reach the heart, where they come to colonize the organ’s tissue lining and valves.
Thankfully, bacterial endocarditis is rare, but when the disease occurs, it can be life-threatening. According to WebMD, the initial symptoms of endocarditis often resemble a common cold or the flu. Most patients just feel sick, in a vague sort of way:
If the infection progresses, however, the results can be disastrous.
Among the numerous complications associated with progressive endocarditis, Medscape lists heart attack, congestive heart failure, aneurysm and stroke.
Doctors should make a diagnosis, authors in the American Family Physician write, using a combination of blood tests (to identify bacteria in the blood) and echocardiography, a form of diagnostic imaging that uses high-powered sound waves to view the internal structure of the heart. Treatment involves the administration of antibiotics.
Some patients are more likely to develop endocarditis. Chief among these at-risk dental patients are people who have certain underlying heart conditions. The medical community now agrees that, prior to undergoing dental surgery, patients who already experience these heart issues should receive antibiotics, a key weapon in the fight against bacterial infection.
As the American Heart Association wrote in a 2016 position paper, prophylactic antibiotics should be prescribed to dental patients who have the following pre-existing complications:
The body’s immune system isn’t designed to fight infectious pathogens when they’ve become attached to artificial materials, including the stainless steel and titanium out of which most heart valves are made. Thus, anyone who has received a prosthetic heart valve is considered at-risk for developing bacterial endocarditis. These patients, the American Heart Association reports, should receive antibiotics prior to dental surgery.
So should some people who were born with congenital heart defects, including those abnormalities that affect the flow of blood. In its position piece, the American Heart Association recommends prophylactic antibiotics for dental patients who were born with cyanotic heart defects but have not yet undergone repair procedures.
According to the US National Library of Medicine, the category of cyanotic defects encompasses all congenital defects that result in a low level of oxygen in the blood, including:
Likewise, the AMA says antibiotics should also be prescribed to patients who have received prosthetic implants for a congenital heart defect, either through invasive surgery or via catheter, within six months of the repair procedure. After the first six months, the organization continues, the risk of contracting an infection drops significantly.
The risk of infection is also increased in patients who have undergone congenital heart disease repairs but have “residual” defects (namely, any valve issue that leads to regurgitation, or leaking) near the patch or prosthetic implant that was used during the repair procedure.
After determining that a dental patient could benefit from antibiotics prior to their surgery, dentists should next evaluate whether or not the scheduled procedure is likely to cause a bacterial infection. Current guidelines from the American Dental Association advise dentists to prescribe antibiotics to at-risk patients prior to all procedures involving the manipulation of gingival tissue, the manipulation of the periapical region of the teeth or the perforation of the oral mucosa.
While these descriptions may seem obscure at first glance, a quick survey of commonly-used medical terms should clear up any confusion:
As we’ve already noted, oral bacteria are allowed to enter the bloodstream through an opening in either gum tissue or the layer of membrane that coats the mouth. As a result, dentists are advised to use extra caution when performing operations in which the gums are disturbed, including tooth extractions, or the oral mucosa is pierced.
Prophylactic antibiotics are given to prevent disease, not to control the disease after it’s begun. With that in mind, it should be obvious that dentists who prescribe antibiotics prior to a procedure tell their patients to take the drugs one day before the operation.
Of course, some patients forget to take their medication, opening themselves up to a life-threatening heart infection. Careful medical practitioners, however, can avert disaster, the American Dental Association reports. “If the dosage of antibiotic is inadvertently not administered before the procedure,” experts at the ADA write, “the dosage may be administered up to 2 hours after the procedure.” That’s also true for cases in which a dentist forgets to prescribe the antibiotics in the first place.
Were you diagnosed with endocarditis after undergoing a dental procedure? Did your loved one contract a severe infection soon after receiving dental care? Our experienced malpractice lawyers can help. Representing patients in New York and New Jersey, the attorneys at Banville Law offer free legal consultations. Contact us today to find more information on your rights – at no cost and no obligation.