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Fokussanering og hjerteklapsubstitution

ABSTRACT

Oversigtsartikel Dato: 08.05.2008

Fokussanering af patienter, der skal have indsat kunstige hjerteklapper, er nødvendig, idet der er risiko for, at dentale foci kan udløse infektiøs endocarditis (IE) omkring hjerteklapprotesen; dette er en livstruende sygdom. Patienterne henvises via en kardiologisk afdeling til egen tandlæge eller en nærværende kæbekirurgisk afdeling, hvor undersøgelse udføres, hvorefter fokussanering udføres enten i hospitalsregi eller i primærsektoren. Patienter, der tidligere har fået indsat kunstige hjerteklapper, tilhører en risikogruppe og skal derfor behandles med antibiotisk profylakse ved tandbehandlinger, der medfører forbindelse med blodbanen.

Elimination of odontogenic infectious foci prior to heart valve substitution. Infectious endocarditis is a life-threatening disease, if untreated. Patients, who need artificial valves inserted, need to have a thorough dental examination including x-rays pre-surgery in order to eliminate potential infectious foci. Patients, who already have received artificial valves, are hereafter grouped as at-risk patients and need prophylactic antibiotic coverage before any dental procedure that can produce bacteraemia. In Denmark, around 470 new cases of bacterial endocarditis were seen in 2005. Good oral hygiene is very important in reducing the risk of endocarditis. The role of antibiotic prophylaxis is being discussed and further evidence is needed. However, the need for antibiotic coverage of at-risk patients is an international consensus-based decision and therefore clinical practice.

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