[Antibiotic prophylaxis of infective endocarditis in stomatology--a survey of cardiologists]. / Antibiotska profilaksa infekcijskog endokarditisa u stomatologiji--kardioloska praksa.

According to epidemiological reports; 14-20% of infectious endocarditis (IE) are associated with previous stomatological procedures (oral surgery, procedures during periodontal and conservative endodontic therapy and intra-ligament anesthesia) which cause transitory bacteriemia for 10-15 minutes. In patients at risk, such short lasting bacteriemia is sufficient for the development of infectious endocarditis. In everyday practice we encounter patients at risk for IE referred to oral surgery (most often tooth extraction) at the Oral Surgery Division, Department of Facial, Maxillary and Oral Surgery, Dubrava University Hospital. Majority of these patients are given IE prophylaxis according to the latest AHA recommendations. For some patients we first consult a cardiologist due to the underlying disease, and as a rule these patients return with cardiologist's advice on IE prophylaxis. We noticed that these recommendations differ between cardiologists. Some cardiologists have for years been recommending the same "prophylaxis" which is not in accord with AHA guidelines. From the available cardiac records we analyzed antibiotic IE prophylaxis before oral surgery in cardiac patients at risk recommended by cardiologists in four Zagreb hospitals in 2003. We collected in total 17 recommendations prescribed by 12 cardiologists. Regretfully, none was in accord with valid AHA guidelines from 1997. Only 6 out of 17 recommendations are in agreement with the outdated guidelines from 1994, which also raises concern. Therefore, we thought it was worthwhile to present these cases, hoping this will stimulate discussion on common guidelines for the benefit of patients at risk for IE.

Influence of oral health on combat readiness in the Croatian army.

The impact of the acute stomatological conditions on the reducing of the combat readiness is an important responsibility for the military planners. Classification of dental health is the primary condition for research and assessment of the army dental readiness for combat. Clinical examination of teeth and mouth included 912 soldiers, 650 of whom were recruits and 262 active duty military personnel. According to their oral status, the examinees were divided into three classes. Class 1 included all those examinees that did not require any dental treatment or reevaluation within 12 months. Class 2 included all of the examinees whose oral health was such that if regularly controlled or followed up, they were not expected to have a dental emergency within 12 months. Class 3 included all of the examinees that required dental treatment to correct both their dental and oral health because the present condition was likely to cause acute stomatological conditions during the 12-month period. This survey designated 130 (14.3%) of the examinees to class 1,178 (19.5%) to class 2, and 604 (66.2%) to class 3. The combat readiness of the 604 (66.2%) examinees in the third class was reduced because a dental emergency can cause the need for dental treatment. The recruits do not have satisfactory dental status even at the beginning of their army service. Unfortunately, active duty military personnel do not have satisfactory dental status either, although they have access to cost-free dental care (prosthetics and orthodontics are not included). This increases the possibility for development of dental emergencies that would have a negative impact on combat readiness.