RECENTLY, I told an elderly patient that it can be very dangerous not to care one’s teeth. Can the neglect of one’s personal oral hygiene result in the death of that person? While I do not want to scare anyone, unfortunately, the answer is yes. Of the ten fatal diseases which originate from deficient oral care, infection of the heart by streptococcus viridans arising from the mouth flora is perhaps among the most common. Rheumatic fever is an acute fever, generally of childhood and adolescence, in which inflammation of the joints (arthritis) is often the most prominent symptom. This may leave the heart permanently damaged. It is a consequence of dental or sometimes throat infections with streptococcus bacteria. The bacteria travel from the infected site through the bloodstream to the heart.

Only a small percentage of persons with this type of infection develop the complication, which appears 10 to 14 days afterwards. High fever of sudden onset is accompanied by arthritis, skin nodules and rashes. Involuntary movements, called chorea, may occur in conjunction with rheumatic fever. In some patients, arthritis affects one joint after another, with overlying skin becoming red and every movement causing pain. In others, however, the joint pain may be mild and thus regarded as ‘growing pains’.

Acquired endocardial disease is mainly rheumatic heart disease involving impaired function of cardiac valves. Acute rheumatic fever can cause immediate crises and death as a result of inflammatory effects to the myocardium (heart muscle). The major medical impact is the possible deformity of heart valves. The thin, translucent heart valve tissue swells and thickens, and, as the inflammation subsides over a long period of time, the valves form scars tissue. In some instances, the tissues fuse together and obstruct the normal blood flow through the valves, a condition known as stenosis.

Valves on the left side of the heart usually receive more damage from rheumatic fever than do valves of the right heart chambers. In some cases, valve flaps are scarred in such a way that they do not close, resulting in regurgitation of the blood. Both obstructive and permanent separation can be detected with a stethoscope as heart murmurs, which are abnormal heart sounds. Both result in heart disease because they overtax the pumping ability of the myocardium. Bacterial invasion of deformed heart valves causes a serious ailment called bacterial endocarditis. This disease is usually fatal if not treated adequately.

The medical and dental literatures provide abundant information on the means and ways of preventing infective endocarditis. Antibiotic drugs taken for long periods before and after an extraction is the traditional method of prevention. But when one is considering approaches to the prophylaxis of infective endocarditis, at least five major elements that play an essential role in defining the probabilities of developing the condition must be taken into account. These are patient’s history, age, the type of heart defect, the type of bacteria and the number of germs that penetrate into the bloodstream.

How should you as a patient act to avoid these dreaded consequences of a simple extraction? First, be cautious with rheumatic fever. If you have ever suffered from rheumatic fever, find out from a heart specialist if your heart is normal. If the cardiologist is even in doubt, personally accept this as your new status, whereby precaution must be taken every time you are to have a dental procedure. But more important yet, obey the laws of oral health so as to preclude the necessity of having an extraction or any other kind of dental surgery.