Bacteremia and orthodontics: Management of patients with and without risk factors for infective endocarditis

Cases of focal oral bacterial infections - including infective endocarditis - have been reported during orthodontic treatment in patients with no previous medical history. This raises the question of whether orthodontic treatment is responsible for the development of these infections.

The aim of this narrative literature review was to determine whether or not bacteremia, directly or indirectly related to orthodontic treatment, is present and what precautions should be taken in orthodontic treatment of patients with and without risk of infective endocarditis.

A narrative literature review was carried out using two keyword searches on PubMed.

Transient bacteremia may occur during everyday activities and dental procedures. This bacteremia is influenced by factors linked to the invasiveness of the procedure and the patient's periodontal indices. In patients at risk of infective endocarditis, the new French professional recommendations do not contraindicate any orthodontic procedure. In patients at high risk of infective endocarditis, stripping, corticotomies, orthodontic exposure of impacted teeth, and insertion and removal of bone anchors require antibiotic prophylaxis. The following procedures are contraindicated in these patients: pulpectomy of temporary teeth, pulp capping of mature permanent teeth, use of bone regeneration membranes, and conservative treatment of peri-implantitis.

Any procedure, whether therapeutic or not, generates bacteremia, which is often minimal and depends on the procedures performed. Orthodontic appliances, because of the length of time they are worn and the difficulty of maintaining good oral hygiene, are likely to generate an additional bacteremia which, in principle, should have no consequences in a healthy patient. Although orthodontic procedures are relatively frequent, studies are rare and often have a low level of evidence.

The role of the orthodontist is to identify the patient's level of risk, to educate and motivate the patient in oral hygiene, and to apply the precautionary measures set out in the new HAS recommendations for patients at risk of infective endocarditis.