Infective endocarditis … what to do to avoid it

Introduction

Endocarditis is an illness where infection develops on the heart valves or other heart tissues. This infection is extremely difficult to treat. It usually requires a long hospital stay and being treated with antibiotics given into a vein. Patients who develop endocarditis can be extremely unwell and often require heart surgery to remove the infected area. Sometimes people die from endocarditis.

What are the symptoms of endocarditis?

Patients with endocarditis develop a temperature and feel unwell, often with symptoms like flu, such as:

• High temperature
• Shivering or chills
• Fatigue
• Night sweats
• Loss of appetite and weight loss

Flu is very common and usually resolves after about 7-10 days. Symptoms which persist for longer than this should be reported to your GP as well as your heart team.

Dental health

The most common source of the bacteria that cause endocarditis is the mouth. Everyone’s mouth carries bacteria but if your teeth and gums are in poor condition the risk of developing endocarditis is increased. Good oral health is therefore particularly important to reduce the risk of endocarditis.

You can help reduce the risk of endocarditis by:

• Tooth brushing twice a day, using a fluoride toothpaste, with supervision from an adult until the age of at least 7-8 years old.
• Having a healthy diet, avoiding sugary snacks and drinks. Drink plain water/milk between meals.
• Visiting your dentist for regular check-ups.
• If your child has toothache or infection in their mouth, dental care should be sought as soon as possible.

The dental team at your dental surgery will give you more detailed advice on how to look after your child’s teeth and gums. There is also information on our website at:
www.leedscongenitalhearts.com

Additional useful information can be found following these links:

British society of paediatric dentistry patient information

Tooth Brushing Habit

Looking after your child’s oral health – Leeds Congenital Hearts

A practical guide to children’s teeth

Dental care for children with CHD

Katie Bear goes to the dentist

Should antibiotics be given before dental care in children and young people at risk of infective endocarditis?

National guidance has advised that antibiotic prophylaxis is not routinely recommended for children at risk of infective endocarditis who are undergoing dental procedures (NICE 2016¹; SDCEP 2018²). The Consultant Paediatric Cardiologists at Leeds Children’s Hospital have reviewed national guidance documents (see below) and have advised that they do NOT recommend antibiotic prophylaxis for any patients under their care. Good Oral health is the best way to reduce the risk of infective endocarditis and your Cardiologist and Nurse Specialists will always discuss this at appointments.

What if I am having difficulties finding a dentist?

• Visit the NHS website which keeps a directory of local dental services www.nhs.uk
• Call NHS 111 who can provide advice and/or provide access to emergency dental services.

Body art: tattoos and piercings

Any procedures that break the skin such as tattooing, body piercing and cosmetic treatments, including eyebrow microblading, Botox and dermal fillers can introduce bacteria into the blood stream and could cause endocarditis.

Whilst we will always advise against these procedures, if you do choose to proceed, the following points will help you to make the procedure as safe as possible:

• Follow the cleaning guidelines from the practitioner until the wound is fully healed. Good hygiene is vital.
• If a piercing/tattoo becomes red and sore, you should remove the piercing and seek medical attention. Antibiotics to treat the local infection may be required.
• If you need to remove a piercing because of infection, you should not replace it until the infection is completely cleared and seriously consider whether you should leave it out altogether.

Further information

References

1. Overview | Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures | Guidance | NICE
   www.nice.org.uk/guidance/cg64
2. Antibiotic prophylaxis | Scottish Dental Clinical Effectiven (sdcep.org.uk)
   www.sdcep.org.uk/published-guidance/antibiotic-prophylaxis/