Tag Archives: ORAL HYGIENE

Infective Endocarditis Prophylaxis in Patients Undergoing Oral Surgery

[btn url=”http://balkandentaljournal.com/wp-content/uploads/2016/04/Infective-Endocarditis-Prophylaxis-in-Patients-Undergoing-Oral-Surgery-1.pdf” text_color=”#ffffff” bg_color=”#81d742″ icon=”fa-file-pdf-o” icon_position=”start” size=”14″ id=”” target=”NewWindow”]Download Article[/btn]

1 / F. Anagnostou2 / S. Dalampiras3 / L. Zouloumis3 / C. Pliakos4

1Postgraduate Program of Hospital Dentistry Dental School of Aristotle University of Thessaloniki, Greece
2National School of Public Health
3Department of OMFS Dental School of Aristotle University of Thessaloniki
4Department of Cardiology AXEPA Hospital Thessaloniki, Greece


Infective endocarditis (IE), an infection of the endocardium that usually involves the valves and adjacent structures, may be caused by a wide variety of bacteria and fungi that entered the bloodstream and settled in the heart lining, a heart valve or a blood vessel. The IE is uncommon, but people with some heart conditions have a greater risk of developing it. Despite advances in medical, surgical, and critical care interventions, the IE remains a disease that is associated with considerable morbidity and mortality. Hence, in order to minimize the risk of adverse outcome and achieve a yet better management of complications, it is crucial to increase the awareness of all the prophylactic measures of the IE.

For the past 50 years, the guidelines for the IE prophylaxis have been under constant changes. The purpose of this paper is to review current dental and medical literature considering the IE prophylaxis, including the new and updated guidelines from the American Heart Association (AHA, 2007 and 2015), the National Institute for Health and Clinical Excellence (NICE, 2015), the European Society of Cardiology (ESC, 2009 and 2015) and the British Society for Antimicrobial Chemotherapy (BSAC, 2006).

Keywords: Infective Endocarditis; Antibiotic Prophylaxis; Bacteraemia; Oral Hygiene


  1. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, et al. Prevention ofinfectiveendocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality Care of Outcomes Research interdisciplinary Working Group. Circulation, 2007; 116:1736-1754.
  2. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, et al. American Heart Association Committee on Rheumatic Fever,Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Diseasein the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation, 2015; 132:1435-1486.
  3. Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB, et al. American Heart Association Rheumatic Fever,Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Diseasein the Young and the Council on Cardiovascular and Stroke Nursing. Infective Endocarditis in Childhood: 2015 Update: A Scientific Statement from the American Heart Association. Circulation, 2015; 132:1487-1515.
  4. NICE.Prophylaxisagainst infective endocarditis, NICE clinical guideline CG64 (2008, updated 2015.). https://www.nice.org.uk/guidance/cg64
  5. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. ESC Committee for Practice Guidelines. Guidelines on the prevention, diagnosis, and treatment ofinfectiveendocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J, 2009; 30:2369-2413. [Crossref]
  6. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. ESC Guidelines for the management ofinfectiveendocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J, 2015; 36:3075-3128. [Crossref]
  7. Gould FK, Elliott TS, Foweraker J, Fulford M, Perry JD, Roberts GJ, Sandoe JA, et al. Guidelines for the prevention ofendocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother, 2006; 57:1035-1042.[Crossref]
  8. Zouridaki T, Zervou-Valvi F. Antimicrobial chemoprophylaxis for prevention ofinfectiveendocarditis in Dentistry. Helle Hospital Dent, 2010; 3:13-20.
  9. Lockhart PB, Loven B, Brennan MT, Fox PC. The evidence base for the efficacy of antibioticprophylaxisin dental practice. JADA, 2007; 138:458-474.
  10. Little JW, Falace DA, Miller CS, Rhodus NL. Dental management of the medically compromised patient. Ed 8. Elsevier, 2013; pp 19-36.
  11. Ratib K, Bhatia G, Uren N, Nolan J. Emergency Cardiology. Ed 2. Hodder Education, 2011; pp 188-202.
  12. Karchmer AW.Infectiveendocarditis. In: Libby P (Ed). Braunwald’s heart disease, a textbook of cardiovascular medicine. Ed 8. Philadelphia: Saunders, 2008; pp 1713-1738.
  13. Ito HO.Infectiveendocarditis and dental procedures: evidence, pathogenesis, and prevention. J Med Invest, 2006, 53:189-198. [Crossref]
  14. Fowler VG Jr, Bayer A.Infectiveendocarditis. In: Goldman L (Ed). Cecil medicine. Ed 23. Philadelphia: Saunders, 2008; pp 537-548.
  15. Hoen B, Duval X.InfectiveEndocarditis. N Engl J Med, 2013; 368:1425-1433.
  16. Bashore TM, Cabell C, Fowler V Jr. Update oninfectiveendocarditis. Curr Probl Cardiol, 2006; 31:274-352. [Crossref]
  17. Velicki L, Šušak S, Čemerlić-Ađić N, Redžek A. Aortic ValveEndocarditis.In: Chen YF (Ed). Aortic Valve. In Tech: 2011; pp 73-89.
  18. Mang-de la Rosa MR, Castellanos-Cosano L, Romero- Perez MJ, Cutando A. The bacteremia of dental origin and its implicationsinthe appearance of bacterial endocarditis. Med Oral Patol Oral Cir Bucal, 2014; 19:67-73.
  19. Mellors J, Horwitz R, Harvey M, Horwitz S. A simple index to identify occult bacterial infectioninadults with acute unexplained fever. Arch Intern Med, 1987; 147:666-671.
  20. Marantz P, Linzer M, Feiner C, Feinstein S, Kozin A, Friedland G. Inability to predict diagnosisinfebrile intravenous drug abusers. Ann Intern Med, 1987; 106:823-828. [Crossref]
  21. Douglas L, Mann MD, Douglas P, Zipes MD, Peter Libby MD, Robert O, et al. Braunwald’s Heart Disease. A textbook of cardiovascular medicine. Ed 10. Saunders, an imprint of Elsevier Inc, 2015; pp 235-236, 1524-1543.
  22. Sakellari D. New guidelines for antimicrobial chemotherapy for cardiologicpatientsin Dentistry. Helle Stomatol Rev, 2008; 52:103-107.
  23. Round H, Kirkpatrick HJR, Hails CG. Further investigations on bacteriological infections of the mouth. Proc R Soc Med, 1936; 29:1552-1556.
  24. Bashore TM, Cabell C, Fowler V Jr. Update oninfectiveendocarditis. Curr Probl Cardiol, 2006; 31:274-352. [Crossref]
  25. Maharaj B, Parrish A. Prevention ofinfectiveendocarditis in developing countries. Cardiovasc J Afr, 2012; 23:303-305. [Crossref]
  26. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al.Infectiveendocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association. Circulation, 2005; 111:394-434.
  27. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, et al. Proposed modifications to the Duke criteria for the diagnosis ofinfectiveendocarditis. Clin Infect Dis, 2000; 30:633-638. [Crossref]
  28. Lockhart PB. The risk forendocarditisin dental practice. Periodontol, 2000; 23:127-135. [Crossref]
  29. Roberts, GJ, Jaffray EC, Spratt DA, Petrie A, Greville C, Wilson M, Lucas VS. Duration, prevalence and intensity of bacteraemia after dental extractionsinchildren. Heart, 2006; 92:1274-1277. [Crossref]
  30. Faden HS. Dental procedures and bacteremia (letter). Ann Intern Med, 1974; 81:274.[Crossref]
  31. Dalampiras S. Antibioticprophylaxisin oral surgery. Odontostomatol News, 2001; 2:61-65.
  32. Almaghout TP, Karagkiozaki V, Litsas I, Zorbas A. The role of the dentistinthe prevention of infective endocarditis. Helle Stomatol Rev, 2005; 49:147-154.
  33. Sconyers JR, Crawford JJ, Moriarty JD. Relationship of bacteremia to toothbrushinginpatients with periodontitis. J Am Dent Assoc, 1973; 87:616-622. [Crossref]
  34. O’Leary TJ, Shafer WG, Swenson HM, Nesler DC, Van Dorn PR. Possible penetration of crevicular tissue fromoralhygiene procedures. I. Use of oral irrigating devices. J Periodontol, 1970; 41:158-162. [Crossref]
  35. Rise E, Smith JF, Bell J. Reduction of bacteremia afteroralmanipulations. Arch Otolaryngol, 1969; 90:198-201. [Crossref]
  36. Felix JE, Rosen S, App GR. Detection of bacteremia after the use of anoralirrigation device in subjects with periodontitis. J Periodontol, 1971; 42:785-787. [Crossref]
  37. Crasta K, Daly CG, Mitchell D, Curtis B, Stewart D, Heitz- Mayfield LJ. Bacteremia due to dental flossing. J Clin Periodontol, 2009; 36:323-332.[Crossref]
  38. Durack DT. Antibiotics for prevention ofendocarditisduring dentistry: time to scale back? Ann Intern Med, 1998; 129: 829-831.
  39. Durack DT. Prevention ofinfectiveendocarditis. N Engl J Med, 1995; 332:38-44.
  40. Strom BL, Abrutyn E, Berlin JA, Kinman JL, Feldman RS, Stolley PD, Levison ME, et al. Dental and cardiac risk factors forinfectiveendocarditis. A populationbased, case-control study. Ann Intern Med, 1998; 129:761-769.
  41. Arapostathis ΚΝ, Topitsoglou V, Kalfas S. Changing the guidelines for the prevention ofinfectiveendocarditis. From the chemoprophylaxis to the classical prevention. Helle Stomatol Rev, 2009; 53:279-290.
  42. Seymour RA, Lowry R, Whitworth JM, Martin MV.Infectiveendocarditis, dentistry and antibiotic prophylaxis; time for a rethink? Br Dent J, 2000; 189:610-616.
  43. Glenny AM, Oliver R, Roberts GJ, Hooper L, Worthington HV. Antibiotics for theprophylaxisof bacterial endocarditis in dentistry (Review). The Cochrane Library, 2013; 10:1-27.
  44. Oliver R, Roberts GJ, Hooper L, Worthington HV. Antibiotics for theprophylaxisof bacterial endocarditis in dentistry (Review). Cochrane Database Syst Rev, 2008; 4:1-23.
  45. American Academy of Pediatric Dentistry. Clinical Affairs committee, Council on Clinical Affairs. Guideline on AntibioticProphylaxisfor Dental Patients at Risk for Infection. Pediatr Dent, 2008-2009; 30:215-218.
  46. Canadian Dental Association. CDA Position onInfectiveEndocarditis. February 2014.
  47. Findler M, Chackartchi T, Regev E. Dental implantsinpatients at high risk for infective endocarditis: a preliminary study. Int J Oral Maxillofac Surg, 2014; 43:1282-1285.
  48. Brincat M, Savarrio L, Saunders W. Endodontics andinfectiveendocarditis – is antimicrobial chemoprophylaxis required? Int Endod J, 2006; 39:671-682. [Crossref]
  49. Schlein RA, Kudlick EM, Reindorf CA, Gregory J, Royal GC. Toothbrushing and transient bacteremiainpatients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop, 1991; 99:466-472. [Crossref]
  50. Vrettos A, Pepelassi E. New biologic concept on the prevention ofinfectiveendocarditis in Dentistry. Helle Stomatol Rev, 2009; 53:59-69.
  51. Löffler C, Böhmer F, Hornung A, Lang H, Burmeister U, Podbielski A, et al. Dental care resistance prevention and antibiotic prescribing modification – the cluster-randomised controlled DREAM trial. Implementat Sci, 2014; 9:27.[Crossref]
Citation Information: Balkan Journal of Dental Medicine. Volume 20, Issue 1, Pages 5–14, ISSN (Online) 2335-0245, DOI: https://doi.org/10.1515/bjdm-2016-0001, April 2016

Assessment of Knowledge and Attitudes to Preserve Oral Health among Older People Aged 60+ in FYROM

[btn url=”http://balkandentaljournal.com/wp-content/uploads/2016/02/Assessment-of-knowledge-and-attitudes-to-preserve-oral-health-among-older-people-aged-60-in-FYROM.pdf” text_color=”#ffffff” bg_color=”#81d742″ icon=”fa-file-pdf-o” icon_position=”start” size=”14″ id=”” target=”NewWindow”]Download Article[/btn]

1 / F. Tozja2

1PZU “ProdentIdadija”, Skopje
2Institute of Public Health, Faculty of Medicine, Skopje, FYROM


Introduction. In the last decade, the impact of oral health on overall health status in the elderly has attracted considerable attention. Elderly people are often not aware that oral diseases and tooth loss can be prevented. Oral health behaviour involves acquisition of individual habits for preservation and maintenance of oral health, such as regular brushing and brushing teeth, using fluoride-rich toothpastes and dental floss, reducing sugar in the diet and habit of regular visits to the dentist. The aim of this research was to assess knowledge and attitude toward maintenance and preservation of oral health in people over 60 years in FYROM.

Methods. This is a cross-sectional study of the population, older than 60 years in FYROM, who use dental services and treatment in public health institution, at the Faculty of Dentistry in Skopje (Clinic of Mouth and Periodontal Diseases) and in the Health Centre in Skopje. As an instrument of this research, a questionnaire which included issues related to oral health behaviour was used for the targeted population. 193 patients answered the questions in this questionnaire.

Results. The age of respondents was significantly associated with the frequency of brushing their teeth and interdental spaces, as well as the habits of frequent dental care visits to the dentist. The gender of the patients had a highly significant effect on the use of fluoride toothpastes and the time that had passed since their last visit to the dentist (p<0.01). Education level in elderly patients significantly affected the knowledge of the individual oral health care.

Conclusion. Respondents with higher education brushed their teeth and interdental spaces more frequently and had regular dental check-ups. Furthermore, they almost always used fluoride toothpaste when brushing their teeth. The increased concern for their own health correlated to a higher level of knowledge, awareness and attitudes about oral health care, and follow recommendations by a dentist. In FYROM, oral health behaviour of patients above 60 years is far behind the levelof care that is achieved in higher developed countries.

Keywords: Oral Health Care; Oral Health Behaviour; Population, old


  1. Petersen PE, Ueda H. Oral Health in Ageing Societies. Integration of Oral Health and General Health. Report of the meeting at the WHO Centre for Health Development in Kobe, Japan, June 2005.
  2. Harford J. Population ageing and dental care. Community Dent and Oral Epidemiol, 2009; 37(2):97-103. [PubMed]
  3. United Nations, Department of Economic and Social Affairs, Population Division. World population ageing. 2007.
  4. Statistical State Office. Statistical Review: Population and social statistics. Nov. 2011 accessed on this website http://www.stat.gov.mk
  5. Coleman P. Improving oral health care for the frail elderly: A review of widespread problems and best practices. Geriatric Nursing, 2002; Vol. 23, No 4.[Crossref]
  6. Andersson K. Oral health in old age. Perceptions among elderly persons and medical professionals. Division of Geriatric Dentistry, Institution ofOdontology, KarolinskaInstitutet, Stoskholm, Sweden, 2006.
  7. Axelsson P, Albandar JM, Rams TE. Prevention and control of periodontal diseases in developing and industrialized nations. Periodontol 2000, 2002; 29:235-246. [Crossref]
  8. Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J, Pine C, Pitts N, Treasure E, White D. Adult Dental Health Survey. Oral Health in the United Kingdom 1998. Office of National Statistics. London: The Stationary Office, 2000; pp 13-400.
  9. Walker A, Cooper A (Ed). Adult dental health survey. Oral health in United Kingdom, 1998. Office of National Statistics. London: The Stationery Office, 2000.
  10. Woods N, Whelton H, Kelleher V. Factor Influencing the Need for Dental Care amongst the Elderly in the Republic of Ireland. Centre for Policy Studies, National University of Ireland, Cork, 2009, accessed on this website www.lenus.ie/hse/
  11. Petersen PE, Kwan S. Evaluation of community-based oral health promotion and oral diseases prevention – WHO recommendations for improved evidence in public practice. Community Dent Health, 2004; 21:319-329.
  12. Vysniauskaite S. Oral health behavior, conditions and care among dentate elderly patients in Lithuania: preventive aspects. 2009.
  13. World Health Organization/Federation Dentaire Internationale. Global Goals for oral health by the year 2000. Int Dent J, 1982; 32:74-77.
  14. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol, 2005; 33:81-92. [Crossref]
  15. Sapuric M. Public health aspects of oral health in elderly, over 65 years in the Republic of Macedonia – state and implications for strategic planning. Master’s Thesis. March 2011.
  16. Health Strategy of the Republic of Macedonia, accessed on the website http://www.moh-hsmp.gov.mk
  17. Todd JE, Lader D. Adult Dental Health 1988. United Kingdom, 1990. London: Her Majesty’s Stationary Office, 1991.
  18. Tseveenjav B, Suominen AL, Vehkalahti MM. Oral health-related behaviours among dentate adults in Finland: findings from the Finnish Health 2000 Survey. Europ J Oral Sciences, 2012; 120(1):54-60. [Web of Science]
  19. ADA, 2007a. American Dental Association. Professionally applied topical fluoride: evidence-based clinical recommendations. J Dent Educ, 2007; pp 393-402.
  20. ADA 2000. American Dental Association. Division of Communications for the Dental Patient. ADA 2000; 131:1095.
  21. Attin T, Hornecker E. Tooth brushing and oral health: How frequently and when should tooth brushing be performed? Oral Health Prev Dent, 2005; 3:135-140. [PubMed]
  22. Berchier CE, Slot DE, Haps S, van der Wejden. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dent Hyg, 2008; 6:265-279. [Crossref]
  23. World Health Organization, Geneva. Oral Health Surveys – basic methods, 1st Edition, 1973.
  24. World Health Organization, Geneva. Oral Health Surveys – basic methods, 2nd Edition, 1979.
  25. World Health Organization, Geneva. Oral Health Surveys – basic methods, 3rd Edition, 1987.
  26. World Health Organization, Geneva. Oral Health Surveys – basic methods, 4th Edition, 1999.
  27. Petersen PE, Aleksejuniene J, Christensen LB, Eriksen HM, Kalo I. Oral health behaviour and attitudes of adults in Lithuania. Acta Odontol Scand, 2000; 58:243-248. [Crossref] [PubMed]
  28. Petersen PE. Sociobehavioural risk factors in dental caries-international perspectives. Community Dent Oral Epidemiol, 2005; 33:274-279. [Crossref]
  29. Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. http://www.who.int/oral_health/media/en/orh_report03_en.pdf, accessed May 2009.
  30. Petersen PE. World Health Organization global policy for improvement of oral health. World Health Assembly 2007. Int Dent J, 2008; 58:115-121. [Webof Science]
  31. Petersen PE. Global Strategies for Promoting Oral Health – the approach of the World Health Organization, 2009.
  32. Petersen PE, Bourgeois DM, Brathhall D, Ogawa H. Oral Health Information Systems towards measuring progress in oral health promotion and disease prevention. Bulletin of the World Health Organization, 83(9). September 2005.
  33. Sheiham A, Netuveli GS. Periodontal disease in Europe. Periodontol 2000, 2002; 29:104-121.
  34. Ling Z, Petersen PE, Wang HY, Bain JY, Zhang BX. Oral health knowledge, attitudes and behaviour of adults in China. Int Dent J, 2005; 55:231-241.[Crossref]
  35. Bourgeois DM, Llodra JC (Ed). Health Surveillance in Europe. European Global Oral Health Indicators Development Project. Report Proceedings 2003. Paris: Quintessence International, 2004.
  36. Bourgeios DM. Health Surveillance in Europe. European Global Oral Health Indicators Development Project. Final Report 2003-2005.
  37. Petersen PE, Kandelman D, Arpin S, Ogawa H. Global oral health of older people. Call for public health action. Community Dent Health, 2010; 27(Suppl. 2):257-268. [PubMed]
Citation Information: Balkan Journal of Dental Medicine. Volume 19, Issue 1, Pages 26–32, ISSN (Online) 2335-0245, DOI: https://doi.org/10.1515/bjdm-2015-0030, July 2015