Take Care of Your Mouth, Your Heart Will Thank You

Bacterial endocarditis, also known as infective endocarditis, is an infection of the heart's inner lining or valves. Infective endocarditis can cause severe complications, including heart valve destruction, heart failure, and other systemic effects if not treated promptly with antibiotics and, in some cases, surgical intervention.

One of the ways bacterial endocarditis begins is through injury in the mouth or gums resulting in bleeding. Streptococcus mutans, a natural resident of the oral cavity, found in plaque formation on teeth, enters the bloodstream. Once in the bloodstream, it can adhere to damaged heart valves or endothelial surfaces, potentially leading to infective endocarditis, a serious infection of the inner lining of the heart chambers and heart valves. (1)

Other ways infective endocarditis can start are through catheters, IV drug use, and dirty needles during illicit drug use.

How bacterial endocarditis forms- steps to infection

• Damage has occurred to heart valves, mechanical valve implants, or pericardium before infection.
• Circulating microorganisms in the bloodstream adhere to the damaged areas.
• Once adhered, the bacteria multiply and cause an immune response.
• The immune response immune cells accumulate, along with fibrin, microorganisms, platelets, and cellular debris.
• This immune response and the resulting mass is called vegetation.
• If not treated, vegetation can further damage heart tissues, interfere with the normal function of heart valves, and even break off to form emboli that can travel to other parts of the body, causing additional complications.

Symptoms of bacterial endocarditis

Early Signs

Fever: Usually the first system, can be accompanied by chills and night sweats.

Fatigue: Low energy is common as the body directs its resources towards fighting the infection.

Severe Symptoms

Heart Murmurs: New or changed murmurs are significant as they can indicate valve damage caused by the growing vegetations.

Blood in Urine (Hematuria): May occur due to embolization (breaking off pieces of the vegetation and traveling to other parts of the body) to the kidneys or other organs.

Late-Stage Complications

Heart Failure: As the disease progresses, it can affect the heart's ability to pump blood effectively, leading to heart failure.

Systemic Infections (Sepsis): If the infection spreads beyond the heart, it can lead to sepsis, a life-threatening body-wide response to infection.

Who is at Risk?

High-Risk Profiles

Previous Heart Valve Surgery:

If you have had heart valve surgery, especially those with prosthetic valve replacements, you are at increased risk. Artificial surfaces can provide an easier attachment site for bacteria compared to natural heart tissue.

Congenital Heart Defects:

Congenital heart defects can put you at heightened risk.

History of Endocarditis:

Having a history of infective endocarditis significantly raises the likelihood of a recurrence. The initial infection might cause structural damage to the heart, making you more susceptible to future infections.

Additional Risk Factors

Intravenous Drug Use:

IV drug use is a well-known risk factor due to the potential for introducing bacteria directly into the bloodstream through non-sterile needles.

Diabetes:

Individuals with diabetes may have a compromised immune system, making it harder to fight off infections, including those that could lead to endocarditis.

Suppressed immune system: either through illness or immune suppression therapy.

Treatment

Antibiotics:

 The initial treatment for infective endocarditis is aggressive antibiotic therapy. The choice of antibiotic depends on the type of bacteria causing the infection, which is determined through blood cultures. Treatment usually lasts at least 4 or more weeks, depending on the response to the antibiotics.

Surgery if life-threatening symptoms

Surgery is considered if there is evidence of heart failure due to valve dysfunction, large vegetations, vegetations that continue to grow despite adequate antibiotic treatment, or recurrent emboli.

Other indications include infections caused by fungi or highly resistant organisms, persistent infections as evidenced by continued fevers or positive blood cultures after a week of antibiotic therapy, or complications like heart block or destructive penetrating lesions.

 Valve Repair or Replacement:

The decision between valve repair and replacement depends on the extent of the damage, the specific valve involved, and the overall health of the patient. 

Prevention

Antibiotic Prophylaxis for Infective Endocarditis

Have you ever wondered why your dentist has you take an antibiotic before some dental procedures?  If you have a history of prosthetic heart valves, a history of endocarditis, certain congenital heart conditions, and heart transplant recipients you are likely prescribed prophylactic antibiotic therapy before dental procedures.

Importance of Oral Hygiene:

Oral Health: Maintaining good oral hygiene is crucial as poor oral health can be a gateway for bacteria to enter the bloodstream, potentially leading to endocarditis. Regular brushing, flossing, and dental check-ups can significantly reduce this risk. Limit sugary foods and drinks, and always brush and rinse your mouth after consuming these.

Regular Medical Check-Ups:

Health Monitoring: Regular medical check-ups help monitor heart health, especially for those with pre-existing conditions that may predispose them to endocarditis. These check-ups can catch potential complications early before they develop into more serious conditions.

Role of Probiotics in Preventing Infective Endocarditis

Review of research on the potential benefits of probiotics in reducing oral and gastrointestinal pathogen levels.

Specific strains that have shown promise in preliminary studies.

Our Immune, Breath, and Plaque Defense Probiotic Blend were carefully selected to fight plaque buildup, maintain a healthy mouth, and improve upper-respiratory tract immunity.

How plaque builds up

Bacteria in the mouth, especially S. mutans, which is one of the major causes of dental caries and bacterial endocarditis, builds up as a sticky film that sticks to teeth. Foods we consume, especially sugars and starches feed the bacteria, The byproduct produces acids and can erode the mineral structure of the teeth, called demineralization. As this process continues, this can eventually lead to dental caries and plaque formation.

If plaque is not removed, it can turn into tartar which is a hard formation over the tooth surface that usually takes professional dental cleaning to remove.

Prevention is key to oral health.

Regular brushing, flossing, and regular dental checkups are essential to prevent dental disease.

In addition, after eating a high carbohydrate meal or sugar, brush your teeth, and rinse your mouth. Adding a proven preventative probiotic can help prevent plaque buildup, which can lead to bacterial endocarditis.

The powerful and effective probiotics listed below are in our probiotic blend and can help fight plaque buildup:

Immune, Breath, and Plaque Defense Probiotic

• Streptococcus Salivarius BLIS K12 1(3)
• Lactobacillus paracasei (4)
• Lactobacillus plantarum (5)
• Lactobacillus rhamnosus (6)

Citations

1. Falk Schwendicke, Franziska Korte, Christof E. Dörfer, Susanne Kneist, Karim Fawzy El-Sayed, Sebastian Paris; Inhibition of Streptococcus mutan s Growth and Biofilm Formation by Probiotics in vitro. Caries Res 16 March 2017; 51 (2): 87–95. https://doi.org/10.1159/000452960
2. Christopher H. Cabell,Elias Abrutyn andAdolf W. Karchmer Bacterial Endocarditis,The Disease, Treatment, andPrevention27May2003https://doi.org/10.1161/01.CIR.0000071082.36561.F1Circulation. 2003;107:e185–e187
3. Kaci G, Goudercourt D, Dennin V, Pot B, Doré J, Ehrlich SD, Renault P, Blottière HM, Daniel C, Delorme C. Anti-inflammatory properties of Streptococcus salivarius, a commensal bacterium of the oral cavity and digestive tract. Appl Environ Microbiol. 2014 Feb;80(3):928-34. doi: 10.1128/AEM.03133-13. Epub 2013 Nov 22. PMID: 24271166; PMCID: PMC3911234.
4. Guo M, Wu J, Hung W, Sun Z, Zhao W, Lan H, Zhao Z, Wuri G, Fang B, Zhao L, Zhang M. Lactobacillus paracasei ET-22 Suppresses Dental Caries by Regulating Microbiota of Dental Plaques and Inhibiting Biofilm Formation. Nutrients. 2023 Jul 26;15(15):3316. doi: 10.3390/nu15153316. PMID: 37571254; PMCID: PMC10421449.
5. Zhang Q, Qin S, Huang Y, Xu X, Zhao J, Zhang H, Chen W. Inhibitory and preventive effects of Lactobacillus plantarum FB-T9 on dental caries in rats. J Oral Microbiol. 2019 Dec 25;12(1):1703883. doi: 10.1080/20002297.2019.1703883. PMID: 32002130; PMCID: PMC6968502.
6. Rungsri, N. Akkarachaneeyakorn, M. Wongsuwanlert, S. Piwat, P. Nantarakchaikul, R. Teanpaisan,Effect of fermented milk containing Lactobacillus rhamnosus SD11 on oral microbiota of healthy volunteers: A randomized clinical trial,Journal of Dairy Science,

Volume 100, Issue 10,2017,Pages 7780-7787,ISSN 0022-0302,https://doi.org/10.3168/jds.2017 12961.(https://www.sciencedirect.com/science/article/pii/S0022030217307567)

Written by Brooke Lounsbury