The Dental Induced Bacteraemia

The Dental Induced BacteraemiaYour Uncle non the same as last sentence who has been taking clopidogrel for a number of geezerhood approaches you, a dental student, to explain something to him. After 2 weeks of weariness and fever, his doctor tardily diagnosed unhealthful Endocarditus by melody cultures. An echocardiogram indicated a bicuspid aortic valve, and sense of hearing to the breast using a stethoscope the doctor could excessively detect a slight go. His doctor had asked him whether he had had every dental discussion recently. He admitted that he had not seen a dentist for a number of years and a cursory investigation revealed dental caries and inflammation of the gums. His argue for avoiding the dentist was be be develop of discharge in the mouth following visits.Your Uncle was quizzical slightly(predicate) a number of things and has asked for your advice. He wants to k instanter what reading the echocardiogram and stethoscope stack reveal. Further, he want s to understand the connection between unwritten health and an individuals general medical exam condition. Specifically, what oral bacteria ar evince, what roles do they play in oral biology, how they could buzz off systemic problems, and what sort of strategies could be employed to prevent infection.. working in your groups, generate a list of leaning outcomes for this topic and knuckle under an individual copy by 23rd November by email to emailprotectedThese eruditeness outcomes will be assessed, and intended tuition outcomes returned to assist you with your report.Individually pull through and through with(predicate) a 2000 word manuscript in a scientific mien addressing the learning outcomes by 7th January (2013) and upload via QMplus. Please note that with QMplus the epoch cut-off is 2355.Learning Outcomes1. To identify the connection between clopidogrel and excessive bleed gums.2. To describe average and abnormal boob valve gradationations.3. To understand and describe the information that echocardiograms and stethoscope gage provide regarding embrace function.4. To explain how oral derived bacterial flora roll in the hay colonise nerve valves.5. To explain why the gist valves argon susceptible to bacterial colonisation.6. To describe when prophylactic antibiotics should be prescribed foregoing to oral interventions.IntroductionBacteraemia is a condition that is ca practised when bacteria visualises the wrinkle stream. When life-size amount of bacteria are present in the inception it can power infections much(prenominal) as meningitis, pericarditis and endocarditus. Individuals with heart valve disorders, prosthetic joints, chronic diseases or weakened immune system are at increased guess of developing infections during Bacteraemia. Dental induced Bacteraemia is ca apply by minor injury from tooth light touch or from dental procedures. In the above problem based learning scenario we have been presented with our uncle who h as been taking Clopidogrel for a number of years and has right off been diagnosed with Infective Endocarditis by blood cultures. Below I will expand on the proposed learning outcomes.2 FIG.1Identify the connection between Clopidogrel and excessive bleeding gums.Clopidogrel is an oral antiplatelet dose which reduces the jeopardize of blood clots forming. It works by preventing Adenosine diphosphate (ADP), which causes platelets aggregation, from binding to its P2Y12 receptors on platelets and shekels activation of the glycoprotein GPIIb/IIIa complex. This prevention reduces the likelihood of clots forming. 1 3SourceHarvey, R Champe, P Lippincott illustrated re get a lines Pharmacology, 4th edition. LWW 2009.rakehell clots can be very dangerous as they can cause blockages of blood vessels reducing the blood supply to an organ. A reduction in blood flow to the brain or heart can cause a stroke or heart attack. This explains Clopidogrels biggest use in patients who have had a rece nt heart attack or stroke it helps to kick downstairs a reoccurrence. 1Taking Clopidogrel therefore can cause excessive bleeding gums. If a blood vessel ruptures when brushing the teeth, through dental treatment or even by eating the gums will carry on bleeding for longer than usual because of the lack of platelet aggregation. http//birthnow.com/wp-content/uploads/2012/05/Clopidogrel.gifDescribe normal and abnormal heart valve formations.A healthy human heart consists of quadruplet chambers cardinal upper atria and two lower heart ventricles and four valves two trucking riglunar and two atrioventricular valves. The aortic and pulmonic valves are both semilunar valves and found in the arteries leaving the heart. The tricuspid and mitral valves are the atrioventricular valves and are found between the atria and ventricles. 5Valves are made up of cusps which basically act as flaps or leaflets that are responsible for the one way flow of blood going into and out of a ventricle. Ea ch valve has three leaflets, except the mitral valve, which barely has two.4 FIG.3Strong thready cord called chordae tendineae in any case known as heart strings are committed to the papillary muscles found on the floor of the ventricles and they act as anchors to go the valves from inverting back into the atria. When the valve restrictings the papillary muscles contract and tenses the chordae tendineae to ensure the one way flow of blood. The valves are in any case supported and surrounded by a fibrous skeleton called annuli that also acts as another anchor. http//www.tokresource.org/tok_classes/biobiobio/biomenu/transport_system/heart-valves.jpg6 FIG.4Blood flows from the right and leftover over(p)(a) field atria into the ventricles through the kick in tricuspid and mitral valves respectively. When the ventricles are full, the tricuspid and mitral valves shut. The ventricles now begin to contract and the pulmonic and aortic valves are forced throw and blood is pumped o ut. Blood from the right ventricle passes through the open pulmonic valve into the pulmonary artery and carries deoxygenated blood to the lungs while blood from the left ventricle is oxygenated and travels through the open aortic valve into the aorta and goes to the rest of the body. This happens in a cycle, between heartbeats the ventricles will then relax, the semilunar valves will close and the atrioventricular valves will open and allow blood from the body and lungs to enter the heart. 7http//mitral-valve-repair.com/wp-content/uploads/2011/01/heart-valves_heart-chambers.jpg pith valves can however malfunction in several ways. Abnormal heart valve formations fall into two main groups Regurgitation and Stenosis. Regurgitation of the valves is when they fail to close properly which causes the backward leakage of blood, this is often happens as a give of coronary heart disease, rheumatoid heart disease or because or bacterial and viral infections including infective endocarditus. 8Mitral disgorgement is the most park heart valve disorder being found in 20% of adults all over the age of 55. 9The backward leakage of blood causes an increase in atrial pressure and the wall of the left atrium will thicken by hypertrophy and possibly dilate. The pulmonary venous pressure will also train which produces pulmonary oedema (fluid accumulation in the air spaces).It also reduces the blood supply to the rest of the so the left ventricle will also vex thicker and the heart rate will increase to try and exert normal cardiac output. Symptoms include shortness of breath, chest pains, dizziness and the caprice becomes faster. 10 11Stenosis of the heart valves occurs when the valve is narrowed and obstructs the forward flow of blood, it is normally a result of a congenital defect which has caused the valve to become inflamed or calcified.12 FIG.5 Aortic Stenosis Aortic valve Stenosis is one of the most harsh valve disorders, when the valve doesnt open correctly there i s reduced blood flow from the left ventricle into the aorta. In severe cases the walls of the left ventricle will become thicker as it has to work harder to maintain cardiac output into the aorta. Symptoms include dizziness, chest pain and an irregular heart beat. If the condition worsens it can lead to heart failure and to a greater extent uncommonly to endocarditus.http//www.heart-valve-surgery.com/Images/aortic-stenosis plastic film-275.jpgAortic Stenosis develops over time because or turbulent blood flow through a usually bicuspid aortic valve. Calcific valvular disease is an inflammatory subprogram and the biggest cause of the disorder, calcification of the valve makes it very stiff and makes it difficult for the valve to open easily. Again as with regurgitation rheumatic fever and endocarditis are also causes of Stenosis. 11 12Valve deformations are more common in the left side of the heart but they do also occur in the right hand side. Stenosis and regurgitation can affect a ll four valves and not only the two mentioned above. 13 Other abnormal valve formations are congenital heart valve diseases which are those present at birth when the aortic or pulmonary valves dont form properly. comprehend and describe the information that echocardiograms and stethoscope can provide regarding heart function.Echocardiography is a non-invasive proficiency used to assess cardiac structure and function by the use of ultrasound. Echoes are used to listen for congestion in the lungs, irregular heartbeats and murmurs. 11 at that place are several types of echocardiograms transthoracic (TTE) are the most common. A device called a probe or transducer is rigid on the chest and high absolute frequency sound waves are used to produce sounds and images of the heart. It picks up echoes of sound waves and transmits them as electrical impulses which are then converted to 2D or 3D moving pictures on the screen. A Doppler echocardiogram awards the movement of blood. If a clear pi cture cannot be formed a small amount of liquid can be injected via IV to give a better picture. 14Echocardiograms show inside information of the chambers including size, volume and thickness of the walls which helps to identify certain disorders including hypertension, the pumping function can also be reviewed and this can show conditions such as cardiomyopathy. Echoes also help with diagnosis of heart valve disorders including those mentioned above. It identifies the basic structures of the valve including thickness and movement and shows any abnormalities such as calcification and scaring. The Doppler will show any leakage through the heart valves and if there is a restriction in blood flow.Echoes of mitral regurgitation will show a dilated left atrium and left ventricle and echoes of aortic Stenosis will show the thickened calcified leaflets.In cases of venture endocarditis a transesophageal echo can be used instead to show high-quality images of the heart and its valves. It is slightly more invasive and a long metro is passed down the oesophagus. 15A stethoscope is a non invasive diagnostic instrument used to listen to or auscultate a patients heart, lungs, pulse and abdomen. It can also be used to help check blood pressure by listening to blood flow restoration when the sphygmomanometer cuff is removed. The diaphragm is placed on the patients chest where it picks up vibrations and amplifies them as sounds to the earpieces going via a bellowing tube. 16http//upload.wikimedia.org/wikipedia/commons/3/3c/Stethoscope_(PSF).pngA healthy heart produces a duplicate beat or lub dub with little other sound when the semi lunar valves open and close. A stethoscope helps detect a heart murmur which makes a whooshing sound after the heart beat, this can indicate solid other problems such as infective endocarditis. 1718 FIG.6 S Mutans adhering to bob up of mitral valve Explain how oral derived bacterial flora can colonise heart valves Explain why the heart valve s are susceptible to bacterial colonisation.strep mutans are a type of bacteria found in dental plaque of the oral cavity that is grandly responsible for causing tooth fall apart and cavities via the process of demineralisation. However on occasion after dental treatment or from brushing the teeth if blood is exposed it can enter the blood stream and cause bacteraemia. Diseased Aortic ValveEndocarditis typically develops on surfaces of the heart, which have become rough and sticky after sustaining endothelial vilify after being subject to turbulent blood flow. (In bicuspid valves blood flow is more turbulent and this creates a high pressure which makes the surface of the valve rough and more susceptible to bacterial colonisation). 19Platelets and fibrin attach to the endochardium surface and form a platform which the bacteria can attach to vegetation is now formed. This vegetation can damage the heart valves and affect how they open and close, or breakaway and cause complications in other areas of the body. The aortic and mitral valves of the left side of the heart are the most common to be affected. S mutants are thought to be responsible for 50% of all bacterial endocarditus cases. Staphylococci found on the skin can also cause it. 11The risk of developing endocarditis is increased in a person who has already got artificial heart valves, general heart valve conditions, congenital birth defects, rheumatic fever and those with a lowered immune system.The problem with when bacteria colonises heart valves is that the valves dont have a designated blood supply to them so white blood cells are unable to fight the infection that is forming there. 20 21Full-size image (41 K)22 FIG.7 Transthoracic echocardiogram (a) and apical four-chamber view (b) demonstrating a well circumscribed vegetation measuring 2 - 1 cm, confined to the posterior mitral valve leaflet and impinging on the left atrium.Describe when prophylactic antibiotics should be prescribed prior to oral treatments.The experimental condition prophylactic antibiotics refer to when antibiotics are given prior to an event as a preventative measure to infection. Where rheumatic fever is still common, get the hang and prevention will prevent rheumatic heart disease and associated endocarditis. 11Previously mass with heart valve conditions and artificial valves were thought to be at high risk of developing endocarditus when receiving dental treatment and other surgical operations so a treatment of antibiotics, usually penicillin were given prior to the procedure in question. Today however this practice is questioned as there were no placebo trials conducted. The large scale use of penicillin as a preventative measure comes with risks such as anaphylactic shock so now as recommended by the National Institute for Health and Clinical Excellence (NICE) it is mainly only offered to those patients who have an infection beforehand and those with artificial valves.ConclusionIn closing to thi s PBL I now understand that the presence of bacteria in the blood can have serious consequences all over the body and not just at the site of entry. In answer to my uncles question about preventing infection it would be worth noting that meticulous oral and skin hygienics is significant in preventing such infections like endocarditis. With regards to oral hygiene a dentist should be seen at least every 6 months so any issues that may be present can be contumacious before they develop further. Brushing twice a day, flossing and keeping ones toothbrush clean are always that can prevent bacteraemia.