An interesting article titled “The interplay among a dental procedure, infective endocarditis, and an acute ischemic stroke” appears in the Journal of the American Dental Association by Momodou G. Bah and et. al., published January 24, 2024. The article discusses a case report that shares the importance of communication and follow-up after dental procedures, especially when it comes to potential complications like infective endocarditis and stroke.
The Case:
A previously healthy 54-year-old woman experienced a cracked tooth while eating, specifically tooth #30 while chewing a popcorn kernel. Her dentist extracted the tooth, but she did not inform the dentist about persistent pain at the site for two weeks, and there were no follow-up calls scheduled. Five weeks later, she developed stroke symptoms and was diagnosed with infective endocarditis, a rare but serious infection of the heart valves.
The Connection:
Tests revealed the presence of Streptococcus mitis bacteria, commonly found in the mouth, suggesting the infection originated from the dental procedure. She also had a computed tomographic angiography scan which showed a left segment middle cerebral artery occlusion. An echocardiogram revealed aortic insufficiency and mitral valve vegetation and regurgitation. While the exact cause-and-effect relationship could not be definitively established, it highlights the potential risk of bacteria entering the bloodstream during dental procedures and contributing to infective endocarditis. In this case, the infective endocarditis is believed to have caused a blood clot that traveled to the brain, and caused the stroke.
Photo by Kamal Hoseinianzade on Unsplash
The woman recovered after a weeklong hospital stay and six week course of IV antibiotics. Due to her infective endocarditis infection, the woman will be considered high risk, and need antibiotic prophylaxis any dental procedures in the future. This case emphasizes the importance of prompt communication with your dentist about any concerns or pain you experience after a dental procedure. Dental procedures like tooth extractions have been linked with transient bacteria that allow oral germs into a patient’s bloodstream. Most patients can clear the bacteria, but those who are have heart conditions and are immunocompromised are at increased risk of developing endocarditis.
The authors state
“Recognizing infective endocarditis subsequent to a dental procedure, including a tooth extraction, as a potential cause of an acute ischemic stroke is vital so that prompt treatment can be initiated.”
This case surely shows the importance of communicating any complications after a tooth extraction to your dentist.