Why a trip to the dentist can be lethal for heart patients?


OXFORD: Twice a day Bill Moulford would spend at least half an hour cleaning his teeth as meticulous in that task as he was with his work as a rocket scientist in the space industry.

“There were times when I would say Bill can’t you just come to bed,” says his wife, Helen, 46  from Wheatley near Oxford.

His teeth were perfect and he had no signs of decay.

But Bill had good reason to be so fastidious. In his early 30s he had been diagnosed with a heart valve problem.

Dental check-ups themselves are a potential risk if they cause the gums to bleed.

This meant that Bill like thousands of Britons, who have weakened heart valves a valve replacement or a pacemaker, was at risk from infective endocarditis.

This is a potentially fatal heart infection often caused when bacteria from the mouth get into the bloodstream as a result of bleeding or inflammation in the gums.

The bacteria congregate around the damaged or replacement valve or pacemaker and as they multiply they can slowly destroy the heart.

The bacteria can also cause a stroke as tiny fragments of diseased tissue called vegetation break free and clog up small blood vessels leading to the brain.

This makes it vital that these patients are scrupulous about their dental hygiene, which is why Bill took great pains to look after his teeth including having regular six monthly check ups.

The check ups themselves are a potential risk if they cause the gums to bleed.

The National Institute for Health and Care Excellence (NICE) recommended ending the use of antibiotics

For years whenever Bill went for this check up he’d be given a single dose of the antibiotic amoxicillin to reduce the risk of infective endocarditis.

But in 2008 the National Institute for Health and Care Excellence (NICE) recommended ending the use of antibiotics in patients such as Bill on the grounds that there was insufficient evidence to justify their continued use.

The decision meant Britain became the only country in the world not to recommend that at risk patients have access to antibiotics before dental treatment (Sweden has since adopted the approach but is believed to be reconsidering its decision).

It is a ruling that Bill’s family and doctors believe cost him his life.

Like an estimated 1.2 million people Bill was born with bicuspid aortic valve where the main valve that helps blood move out of the heart and around the body is faulty.

Doctors reassured him that his valve was unlikely to need replacing until he reached his 50s or 60s.

In the meantime he was told to eat a healthy diet take regular exercise and pay careful attention to his teeth.

Then in September 2014 Bill went for a routine appointment with a new dental hygienist.

After the visit Bill complained that the hygienist had been very vigorous recalls Helen.

It hurt him and his gums were bleeding she says.

Around six weeks later Bill developed a dry cough   often an early sign of a heart infection.

Suspecting a chest infection doctors gave him antibiotics for a week followed by inhaled steroids.

But he woke most nights soaked from head to toe in sweat and within weeks his cough became so violent he cracked a rib, put his back out, and was in constant pain.

His cough stopped him sleeping and it got to the point where we could not share a bed, says Helen.

Over the next five months Bill saw five different GPs during 26 surgery visits. But blood tests and X-rays failed to reveal what was wrong. He was unable to work lost a stone in weight and became breathless very easily.

When he was finally admitted to hospital a cardiologist quickly diagnosed him with infective endocarditis and planned to put him on powerful antibiotics for a month to banish the infection before he had surgery to replace the ruined valve.

But within hours tragedy struck.

Helen was just leaving the hospital to collect their daughter Elizabeth four from nursery and was kissing Bill goodbye when the monitors showed his heart had started racing wildly says Helen.

Doctors rushed in but she recalls. “Suddenly Bill put his hand on his chest looked me in the eye and said, “My heart s stopped…” He died right in front of me. “

Doctors performed CPR on Bill s chest for 40 minutes in a futile bid to revive him.

Bill was just 46 when he died early last year.

The NICE decision on antibiotics for patients such as him during dental treatment contrasts with that of leading medical bodies across the world including the

European Society of Cardiology which recommends antibiotics for patients most at risk including those diagnosed with defective heart valves or fitted with artificial replacement valves or pacemakers.

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