RESUMO
Infective endocarditis is a rare but usually severe and often fatal inflammatory disease affecting the endocardial surface, native and prosthetic valves or cardiac devices. Besides various staphylococcus species, oral viridans streptococci are known to play a crucial role in the development of endocarditis, especially in patients with underlying cardiac conditions, such as valve replacement, congenital heart disease and a history of previous infective endocarditis. Particularly undetected persisting odontogenic infections and their secondary symptoms, as well as various therapeutic measures for their prevention and treatment, may lead to bacterial transfer from the oral cavity into the bloodstream, eventually enabling bacterial adherence to endocardial surfaces and thus promoting infective endocarditis. The administration of antibiotics prior to dental interventions in order to prevent this mechanism was initially recommended almost seventy years ago and has been the subject of research and intensive discussion ever since. Recently, numerous professional societies worldwide have published guidelines and updates on the prevention of endocarditis with divergent recommendations regarding the requirement of prophylactic antibiotic regimen prior to dental procedures. The objective of this article was therefore to review the currently available literature regarding oral health and infective endocarditis and to examine the rationale behind the inconsistent recommendation situation, critically.
RESUMO
Bemcentinib is a newly developed AXL inhibitor that is currently under investigation in phase II trails for the treatment of acute myeloblastic leukemia (AML). Clinical and radiographic findings in this case were very similar to cases of MRONJ in patients receiving Sunitinib or other anti-angiogenetic substances, assuming that Bemcentinib may cause similar oral side effects. We present a male 81-year-old patient with a manifestation of alveolar bone necrosis at the central upper incisors following a 2-month regimen with the AXL-inhibitor Bemcentinib, administered for the treatment of secondary acute myeloblastic leukemia (sAML). Due to the duration of less than 8 weeks, the osteonecrosis was diagnosed as necrotizing periodontitis, but the intraoral clinical and radiographic findings were also compatible with the differential diagnosis of medication-related osteonecrosis of the jaw (MRONJ, stage II). Following to discontinuation of Bemcentinib, the affected bone was surgically revised including the removal of a demarcated bone sequester under preventive antibiotic treatment (metronidazole 400 mg t.i.d.). We hypothesize that Bemcentinib might increase the susceptibility for osteonecrosis of the jaw, probably related to its antiangiogenic effects and the resulting modulation of host immune response. Based on the current observations, it can be assumed that oro-dental health might be significant also prior and during treatment with Bemcentinib for the prevention of MRONJ.
