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. 2017 Jun 15;64(12):1678-1685.
doi: 10.1093/cid/cix237.

Oral Streptococcal Endocarditis, Oral Hygiene Habits, and Recent Dental Procedures: A Case-Control Study

Xavier Duval  1 , Sarah Millot  2 , Catherine Chirouze  3 , Christine Selton-Suty  4 , Vanessa Moby  5 , Pierre Tattevin  6 , Christophe Strady  7 , Edouard Euvrard  8 , Nelly Agrinier  9 , Daniel Thomas  10 , Bruno Hoen  11 , François Alla  12 ; EI-dents Association pour l'Etude et la Prévention de l'Endocardite Infectieuse (AEPEI) Study Group
Collaborators, Affiliations
Free PMC article

Oral Streptococcal Endocarditis, Oral Hygiene Habits, and Recent Dental Procedures: A Case-Control Study

Xavier Duval et al. Clin Infect Dis. .
Free PMC article

Abstract

Background.: We aimed to compare oral hygiene habits, orodental status, and dental procedures in patients with infective endocarditis (IE) according to whether the IE-causing microorganism originated in the oral cavity.

Methods.: We conducted an assessor-blinded case-control study in 6 French tertiary-care hospitals. Oral hygiene habits were recorded using a self-administered questionnaire. Orodental status was analyzed by trained dental practitioners blinded to the microorganism, using standardized clinical examination and dental panoramic tomography. History of dental procedures was obtained through patient and dentist interviews. Microorganisms were categorized as oral streptococci or nonoral pathogens using an expert-validated list kept confidential during the course of the study. Cases and controls had definite IE caused either by oral streptococci or nonoral pathogens, respectively. Participants were enrolled between May 2008 and January 2013.

Results.: Cases (n = 73) were more likely than controls (n = 192) to be aged <65 years (odds ratio [OR], 2.85; 95% CI, 1.41-5.76), to be female (OR, 2.62; 95% CI, 1.20-5.74), to have native valve disease (OR, 2.44; 95% CI, 1.16-5.13), to use toothpicks, dental water jet, interdental brush, and/or dental floss (OR, 3.48; 95% CI, 1.30-9.32), and to have had dental procedures during the prior 3 months (OR, 3.31; 95% CI, 1.18-9.29), whereas they were less likely to brush teeth after meals. The presence of gingival inflammation, calculus, and infectious dental diseases did not significantly differ between groups.

Conclusions.: Patients with IE caused by oral streptococci differ from patients with IE caused by nonoral pathogens regarding background characteristics, oral hygiene habits, and recent dental procedures, but not current orodental status.

Keywords: case-control study; dental status.; endocarditis; hygiene; prophylaxis.

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Conflict of interest statement

Conflict of interest statement:

The authors have no commercial or other associations that might pose a conflict of interest

Figures

Figure 1
Figure 1
Flowchart Note:​ IE: infective endocarditis * Discordant microorganisms : Two microorganisms responsible for a single IE, from two different origins. ** See methods.
See this image and copyright information in PMC

Comment in

  • Reply to Raoult.
    Duval X, Millot S, Chirouze C, Selton-Suty C, Moby V, Tattevin P, Strady C, Euvrard E, Agrinier N, Thomas D, Hoen B, Alla F. Duval X, et al. Clin Infect Dis. 2018 Mar 5;66(6):982-983. doi: 10.1093/cid/cix928. Clin Infect Dis. 2018. PMID: 29088327 No abstract available.
  • Endocarditis Prophylaxis.
    Raoult D. Raoult D. Clin Infect Dis. 2018 Mar 5;66(6):982. doi: 10.1093/cid/cix925. Clin Infect Dis. 2018. PMID: 29088356 No abstract available.

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