My motivation for championing Photodisinfection technology stems from my own personal experiences. I almost lost my daughter when she was only 2 due to antibiotic resistant bacterial infection. This was without a doubt, the worst time of my life and spurred my passion to develop technologies that help people prevent or infections using a combination of photosensitizer and light therapy. It takes a decade to develop technologies and another decade sadly, to get the market to adopt. In short, only passion and personal commitment driven out of life experiences such as mine, make it possible to survive the ordeal of developing and commercializing disruptive new technologies. And along the way, there are the inspiring moments that fuel this passion…
My friend Jeremy (name changed to protect his identity) is a healthy mid-forties man who is in great shape. He eats well, he exercises regularly; he is lean and very fit. He does a great job of work/life balance. A few weeks ago, he almost died. This came as such a shock of all of us in our small community who know and love him. Jeremy suffered a stroke and ended up with open heart surgery to replace his heart valve. All of this from the Infectious Endocarditis that he developed from having his teeth cleaned. How is this possible that a healthy man can be so drastically affected by the simple act of teeth cleaning, one wonders? I am sharing his story in the hopes that others can be spared a similar ordeal and to create awareness of potential risks to dental work for those of us with unknown heart conditions.
The mouth is full of bacteria- some estimates suggest that there are over 1,000 different kinds of bacteria. Gram negative bacteria and tenacious biofilm reside under the gum line. These are the bacterial communities responsible for gum disease and thrive in the non-oxygenated environments down deep between the tooth and the gums. Once these bacteria get below 5 mm from the gumline, it is virtually impossible for regular brushing or flossing to eliminate them. Both mechanical debridement and Photodisinfection is needed to eliminate these bacteria. Mechanical debridement alone is not enough; studies have documented that 62% of bacteria are left behind mechanical debridement allowing the bacteria to continue to make inroads into the gums.
When mechanical cleaning occurs, this physical disruption allows these gram negative bacteria to enter into the blood stream (bacteremia). For most people, our immune systems are easily able to control these gram negative bacteria. However, for immunocompromised people, or people with certain kinds of heart conditions (bicuspid aortic valve), the bacteria are able to evade the immune system and lodge themselves with the heart valves leading to the potentially fatal condition called Infectious Endocarditis. The valves of the heart are vulnerable to infection because they do not receive any dedicated blood supply so white blood cells, our defensive immune mechanisms, cannot directly reach the valves via the bloodstream and also therefore limit the accessibility of medication (e.g. antibiotics). If bacteria are able to attach to a valve surface and forms a ‘vegetation’, the host immune response is blunted.
Jeremy had his teeth cleaned October 29th and then again November 5th. Few weeks later, he was feeling light-headed and suffered from some vision impairment. He did seek some medical attention, had some tests, but due to his excellent physical condition, some critical confirmatory tests were not undertaken (this is typical in Canada). The doctors were not suspecting infectious endocarditis. He did see a neurologist three weeks later. By January he was suffering from flu-like symptoms and night sweats; by mid-January he had pain in his quadriceps and hamstring muscles. He thought he was suffering from a common cold. By Feb 9th, he had pain in his side and sought medical attention and had a series of tests. By Feb 12th, he was in a hospital being given intravenous antibiotics for 8 days but they were unsure of which bacteria were involved. During this time, however, they diagnosed Infective Endocarditis (inflammation of the inner tissue of the heats eg valves caused by infectious agents) and a bicuspid aortic valve (which occurs in 1-2% of the population).
The doctors changed his antibiotics and released him from hospital Feb 20th. On Feb 23rd he was suffering from headache and feverand noticed that the peripheral vision in his left eye was affected. By Feb 24th, his headaches and fever continued and he was readmitted to hospital due to low blood pressure. New tests indicated that ‘vegetation’ was growing around his heart valve and some of this material broke loose and caused him to have a stroke. Jeremy was also experiencing infection in his toes which gave the heart doctors additional concern. By Feb 26th, Jeremy had a 5 hour open heart surgery and had a valve replaced.
Despite all the antibiotics Jeremy had been taking since Feb 12th, the ‘vegetation’ had grown significantly in only a matter of weeks and was affecting his heart function. This vegetation matter that was accumulating around the bicuspid valve had broken off preventing blood flow to the brain causing a stroke. All this from bacteria escaping into the blood stream during a simple tooth cleaning exercise. Even tooth brushing can cause bacteria to enter into the blood stream.5 Once in the blood stream, these bacteria attach to the surface of the heart valves and can attack the heart valve causing growths on the valve, holes in the value (as was the case with Jeremy) or scarring of the valve tissue causing the valve to leak or to become stenotic. Left untreated, Endocarditis can destroy heart valves and can result in fatal outcomes.
Eight doctors and a major surgery were needed to keep Jeremy alive. Endocarditis is not common in people with healthy normal hearts. Those at greatest risk are people with a damaged heart valve, an artificial heart valve or other heart defects (as in Jeremy’s case). But how do we know if we do not have a normal heart and that we may be at risk of serious complications from simple dental work? Jeremy had no idea that he had a bicuspid aortic valve (only 1-2% of people have this condition) and only discovered this the hard way. Knowledge and prevention are so important which is the purpose of this article. If there is a history of heart defects in your family, you may be at risk and should take extra precautions during dental work. Prevention is always the best measure and always well worth the extra time and money spent. Even though you may not be at a serious risk, isn’t peace of mind worth it?
Written for Jeremy….