Orthodontic treatment can help correct problems with crooked teeth or a misaligned bite. Thousands of children and adults across Australia wear special braces to help correct these problems, but some people are at risk from unwanted complications or side effects. Learn more about endocarditis, and find out how orthodontic treatment can affect the risk of this disease.

How endocarditis affects the body

Endocarditis is a serious heart infection that occurs in the valves or inner membrane of this vital organ. Most commonly, an infection or disease in another part of the body spreads through the bloodstream to the heart, causing inflammation and blood clots.

Infective endocarditis is relatively rare in Australia, but the disease can cause life-threatening symptoms. Around 15 to 20 percent of people with the condition die in hospital, so it's important to understand which patients are at higher risk of the infection.

Risk factors

If you have a healthy heart and no other medical conditions, the risk of endocarditis is low. People with prosthetic heart valves, congenital heart disease or previous endocarditis symptoms are at the highest risk of infection. There's a moderate risk of infection for patients with some other heart conditions, including congenital malformations. People with pacemakers are generally at the same risk of infection as the rest of the population.

If you are in one of the higher risk categories, certain procedures and treatments in other parts of the body can increase the risk of endocarditis, including orthodontics and other types of dentistry.

These treatments increase the risk of a bacterial infection in the mouth. For example, an extraction often leaves an open wound that becomes susceptible to infection. Similarly, orthodontic appliances like braces can trap food debris and bacteria, leading to an infection. If bacteria from these infections get into the bloodstream, the patient is at increased risk of endocarditis, especially if he or she already has problems with his or her heart.

Medical opinion

Medical opinion about precautions you can take varies around the world. For example, the American Heart Association recommends that patients at higher risk of infection should take precautions before certain types of treatment, including orthodontic bands. In the United States, physicians now issue certain patients with wallet cards warning of the risks of infective endocarditis.

Australian dentists often offer similar advice, but a report by the Australian Dental Association warns that there is not yet a single set of universally accepted guidelines. As such, it's always important to tell your dentist about any problems you have (or have had) with your heart before you undergo any type of treatment.

Antibiotic prophylaxis as a precaution

Patients at risk of infective endocarditis should undergo antibiotic prophylaxis before orthodontic treatment. A course of strong antibiotics before dental work cuts the risk of post-treatment infection, especially in patients with other underlying medical conditions. In fact, you can take the antibiotics up to two hours after treatment, and the risk of infection will still decrease.

In some cases, high-risk patients are already taking antibiotic medication for another medical condition. In these cases, your dentist should prescribe an antibiotic from a different class, to make sure the treatment has the desired effect. For example, if you are already taking amoxicillin, your dentist could prescribe clindamycin.

Other precautions

Your dentist may take other precautions if you are at higher risk of the infection.

Your dentist should not continue with orthodontic treatment if you have any signs of oral infection. He or she may suggest that you use an antibacterial mouthwash for a week to control a minor infection.

Different types of orthodontic attachment can also cut the risk of infection. For example, dentists agree that orthodontic bands are more problematic than bonded attachments. Orthodontic bands can cause tissue damage, which increases the risk of infection, so your dentist may recommend bonded attachments instead. Following orthodontic treatment, regular visits to a hygienist are also important. He or she can check for any early signs of infection. Supportive therapy from a hygienist can help deal with minor symptoms before more serious problems occur.

Orthodontic appliances can increase the risk of an oral infection that could spread to other parts of the body. If you have a heart condition, talk to your dentist about the precautions you should take to avoid infective endocarditis. For more information, contact a local orthodontics specialist.