Oral Streptococcal Endocarditis, Oral Hygiene Habits, and Recent Dental Procedures: A Case-Control Study

AIMS: To compare oral hygiene habits, oro-dental status, and dental procedures in patients with infective endocarditis (IE) according to whether the IE-causing microorganism originated in the oral cavity. METHODS: We conducted an assessor-blinded case-control study in 6 French tertiary-care hospitals. Oral hygiene habits were recorded using a self-administered questionnaire. Oro-dental status was analysed by trained dental practitioners blinded to the microorganism, using standardized clinical examination and dental panoramic tomography. History of dental procedures was obtained through patient and dentist interviews. Microorganisms were categorised as oral streptococci or non-oral pathogens using an expert-validated list kept confidential during the course of the study. Cases and controls had definite IE caused either by oral streptococci or non-oral pathogens, respectively. Participants were enrolled between May 2008 and January 2013. RESULTS: Cases (n=73) were more likely than controls (n=192) to be aged < 65 years (OR: 2.85; 95% CI 1.41-5.76), to be female (OR: 2.62; 95% CI 1.20-5.74), to have native valve disease (OR: 2.44; 95% CI: 1.16-5.13), to use toothpicks, dental water jet, interdental brush and/or flossing (OR: 3.48; 95% CI: 1.30-9.32), and to have had dental procedures during the prior three months (OR: 3.31; 95% CI: 1.18-9.29), while they were less likely to brush teeth after meals. Gingival inflammation, calculus and infectious dental diseases were not significantly different between groups. CONCLUSIONS: Patients with IE caused by oral streptococci differ from patients with IE caused by non-oral pathogens regarding background characteristics, oral hygiene habits, and recent dental procedures, but not current oro-dental status.