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The incidence and mortality of infective endocarditis has essentially remained unchanged over the years. However, there has been a change in the demographics of IE with it being seen in older patients and more strongly associated with underlying comorbid conditions. More specifically there has been a significant increase in IE due to Staphylococcal Aureus. Contrary to traditional teaching, IE is not strongly associated with recent dental work. Despite the widespread practice, the evidence for endocarditis prophylaxis is "weak". Unfortunately it
is probably not possible to do a definitive trial to answer the question whether endocarditis prophylaxis is helpful or harmful. As a result, we will need to continue to rely on registry data to help guide us with regards to the natural history of infective endocarditis and its treatment. Both the British and American guidelines have recently changed and both reflect our new understanding of infective endocarditis.

Cardiac Issues for the Practicing Dentist

Despite advances in diagnosis and treatment, cardiovascular disease continues to be very common and continues to be the leading cause of death worldwide. Treatment has been shown to slow the natural history of cardiovascular disease but it is not capable of altering the biological process. As a result, patients are living longer. This means that dental practitioners will be asked to treat patients who have a variety of cardiac problems and have more complex cardiac disease. It is important that dental practitioners be aware of some of the more common cardiac problems, their diagnosis and treatment (e.g. angina, atrial fibrillation, heart failure, coronary artery disease with stents, valvular heart disease) -
especially with respect to potential issues for the dental practitioner.

Preventing Cardiovascular Disease - The Ongoing Challenge

CVD represents a cluster of disorders with complex interactions between multiple risk factors. There are 6 major risk factors that lead to enhanced risk of developing CVD. At the beginning of the 20th century, cardiovascular deaths were responsible for <10% of all deaths worldwide. Today, that figure is >30% and cardiovascular disease is the leading cause of death with about 80% of the burden now occurring in developing countries. (Nearly twice as many as compared to developed countries). A global CVD epidemic is rapidly evolving. In Canada, we have seen a decrease in CV events through a combination of population based education and aggressive medical management of CV risk factors such as hypertension, cholesterol and smoking. However, we are seeing a decrease in the level of activity of adult Canadians, increasing obesity and as a result increasing adult onset diabetes mellitus. In the near future, this may offset the gains we have made in decreasing CV events to date. However, more importantly, we are now seeing the same issues in our children with an increasing percentage of Canadian children being obese; type II diabetes mellitus now being diagnosed in teenagers; and increasing numbers of young adults with hypertension. This would imply that there is a good chance that our children will not live as long as the current generation.

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