What’s the deal with dentistry and bimitral valve prolapse (BVP)? How does one affect the other? And, what does a dentist do differently for one with BVP? How do you even know you have BVP? Is it like a murmur?
Dentistry and BVP? It just seems such an odd combo…
What’s the SD?
Um…
Here you go
Mitral valve prolapse. Bi mitral prolapse is just that both leaflets of the Mitral valve are prolapsed.
Valve conditions theoretically put you at greater risk of bacterial endocarditis, mostly because the flow in the heart isn’t correct and it is possible for infection to build up in ares of “stagnant” flow (like weed in stagnant areas of a fast flowing river). As the mouth is full of bacteria and dental work causes this bacteria to enter the blood stream it was felt that people with known valve problems should have antibiotics before dental work in order to reduce the risk of bacterial endocarditis.
As the actual risk of developing endocarditis after dental work is so small, the guidelines are moving away from this routine use of antibiotic prophylaxis for people with valve problems.
Mitral prolapse is diagnosed clinically by a systolic murmur heard loudest over the apex (approximately the area of the left nipple in men), and more accurately by a cardiac ultrasound (ECHO) showing abnormal flow over the valve. It can be treated in severe cases by valve replacement surgery, but is usually asymptomatic.
To elaborate on what irishgirl said, the new recommendations from the American Heart Association no longer advise antibiotic prophylaxis for any form of mitral valve prolapse. By and large, such preventative treatment is now reserved for people with “complex” congenital heart disease, people who’ve had endocarditis previously, and those with mechanical heart valves.
Here is a nice succinct summary.
That is so succinct that it is no longer plain whether mitral stenosis is considered worthy of preventative antibiotic treatment for dental procedures.
Well, since the most common cause of mitral stenosis is infectious carditis, I’d recommend dental prophylaxis unless the cause of the stenosis is know to not be from previous infection.
This is one time I’m gonna have to disagree with you Qad (a dangerous move to be sure 
). The most common cause of mitral stenosis continues to be rheumatic heart disease (although we may be seeing fewer cases of acute rheumatic fever).
Think of it this way: why would a normal mitral valve be the site of endocarditis? Indeed, if the mitral valve ever does get affected by infectious endocarditis, it is almost certainly because the valve is already damaged. Since there are actually very few causes of mitral stenosis other than rheumatic fever, what else could have caused the stenosis? Except for the very uncommon congenital mitral stenosis and the equally uncommon Whipples Disease and Carcinoid Syndrome, I’m not even sure there are any other causes.
Ah! Look here.
In other words, rheumatic heart disease is responsible for 99% of cases of mitral stenosis significant enough to lead to valve replacement.
It just occurred to me that by “infectious carditis” you may mean rheumatic carditis and not infective endocarditis. If so, my apologies.
It just occurred to me that by “infectious carditis” you may mean rheumatic carditis and not infective endocarditis. If so, my apologies.
Yes, I meant rheumatic carditis. Sorry, I used niche terminology, not universally recognized.