Mitral Valve Prolapse

Mitral Valve Prolapse a valvular heart disease characterized by the

displacement of an abnormal mitral valve leaflet into the left atrium during
contraction.
The mitral valve is located in the heart between the left atrium and the left
ventricle and consists of two flaps called leaflets. In a normal functioning heart,
the leaflets open and shut to allow blood to flow from the atrium to the ventricle in
only one direction. A person that has MVP, one or both of the leaflets are
enlarged and do not close properly. When the heart contracts, one or both of the
flaps collapse backward into the left atrium, and in some cases, allows a small
amount of blood to leak backward through the valve back into the left atrium. This
condition is known as mitral regurgitation. Mitral regurgitation can lead to the wall
of the heart becoming enlarged because of the amount of extra pumping it is
having to do. Mitral valve prolapse is also known as click-murmur syndrome
because when the valve does not close properly, a clicking sound is made
followed by a murmur.
This condition is found in only 2-3% of the population and more common
in females than males. The cause is still unknown. MVP can be treated with
medication or surgery can be performed to replace or repair the defective valve.
Some of the medications that are used to treat this condition are Beta blockers,
diuretics, and heart rhythm medications.
Most physicians will suggest taking an antibiotic before dental visits or
dental procedures that may make contact with blood. Patients who maintain
proper oral health dont have as large of a risk or need for antibiotics as those
with a diseased oral cavity. Taking antibiotics before treatment is a great
precaution for patients with CHD/MVP but is not always required by physicians or
dentists. A medical release from the physician is suggested to verify the condition
and help determine the need for antibiotics and special procedures for the
patient.
Patients with MVP are more susceptible to caries and periodontal
diseases, mainly due to medications prescribed. These medications commonly
cause xerostomia which can increase the risk for caries, periodontal disease and
halitosis. It is important to continue taking the prescription medications to control
the disease while maintaining good oral health in the process. Having good oral
health can reduce the risk of endocarditis. If the mouth is unhealthy and full of
bad bacteria, it can be harmful or even life threatening to patients with Congenital
Heart Disease. Bacteria from the mouth can go into the blood stream through
weakened or diseased oral tissues and be detrimental and even fatal to the
patient.

Rinsing with antimicrobial agents containing chlorhexidine gluconate or

providone-iodine is recommended prior to manipulation of dental tissues.
Prophylaxis is recommended but not required for dental procedures likely to
induce the significant bleeding of hard or soft oral tissues. This includes most
surgical and non-surgical periodontal therapy. Dental procedures that involve
manipulation of soft tissue and bleeding can produce transient bacteremias.
These procedures include periodontal probing, extractions, implant placement
and tooth reimplantation, periodontal treatment procedures likely to cause
bleeding, endodontic surgery or instrumentation beyond the root apex,
subgingival placement of antibiotic fibers or strips, and the use of oral irrigators or
air abrasive polishing devices.
Routine periodontal therapy is not appropriate within the first 6 months of
valve replacement. If a series of dental procedures is required, an interval of 9-14
days between procedures may minimize the risk of resistant strains of
organisms. If unanticipated bleeding occurs during low risk dental procedures,
antibiotics administered within two hours may have some benefit although there
is no evidence of prophylactic benefit if administered four or more hours after the
incident.
Periodontal health is an extremely important goal for the lifetime of the
patient. Brushing and flossing twice a day, and frequent recall visits can help
these patients maintain a healthy oral cavity. Up to date radiographs are also
helpful in visualizing bone loss. Maintaining proper nutrition, as well as
terminating or decreasing the use of tobacco and alcohol is very important in
preventing periodontal disease and/or oral cancer.

QUESTIONS:
1. What percent of the population is affected by this disease?
2-3% and more females than males
2. How can MVP be treated?
Medication or surgery
3.

Patients with Congenital Heart Disease/Mitral Valve replacement are at a

risk of what condition if they dont maintain proper oral health?
Endocarditis.

4.

Are antibiotics actually required for patients with CHD? Why or Why not?
No, it suggested by doctors to reduce risk of endocarditis but not a
requirement if you maintain a healthy oral cavity. Patients who have
oral health issue should definitely consider taking premedications
and might actually be required by physician or dentist. Some Dental
offices may require the use of premedication with all of their CHD
patients to reduce risk.
5. How long is required to wait before performing routine
periodontal therapy after valve placement?
6 months
6. What procedures can produce transient bacteremias?
Periodontal probing, extractions, implant placement and tooth
reimplantation, periodontal treatment procedures likely to cause
bleeding, endodontic surgery or instrumentation beyond the root
apex, subgingival placement of antibiotic fibers or strips, and the use
of oral irrigators or air abrasive polishing devices.
7. How long of interval is required if a series of dental procedures is
required?
9-14 days

Works Cited:
Rethman, Michael P. New Guidelines for Antibiotic Premedication.
The Journal of Professional Excellence. Dimensions of Dental Hygiene,
May 2007. Web 19 November 2015.
Wilkins, Esther M. Clinical Practice of the Dental Hygienist. Philidelphia:
Lippincott Williams & Wilkins, 2013. Print
Adult Congenital Heart Disease and Dental Issues: Whats Up With
Preventive Antibiotics? Adult Congenita Heart Association.
Rethman, Michael, P. New Guidelines for Antibiotic Premedication.
Dimensions of Dental Hygiene. April 2007. dimensionsofdentalhygiene.
Web. Nov 2015
J Periodontal 2002;73:954-968