Joke tooth decay

Many people have "tooth decay" (dental caries).

It may still hurt from time to time,

As the saying goes, toothache is worse than a serious illness.

Actually, this is really not a joke.

A small decayed tooth,

Let the hero below

Heart, brain, lung, liver and kidney failure,

There are usually four important organ failures,

The mortality rate can reach 100%!

Michael horvath, a foreigner who has lived in Guangzhou for 14 years, has just been rescued from a rescue caused by dental caries.

4 1 year-old, married in Guangzhou, married a Guangdong girl, and will have their first baby next month. However, one day in early April, he had a high fever for a week and soon developed symptoms such as shortness of breath and chest tightness. He was diagnosed with "infective endocarditis" and caused five organ failures.

I thought it was a common fever and went directly to the ICU.

I thought it was just a common cold and fever, so I could go home after taking some medicine. Unexpectedly, the alert emergency doctor found that the situation was not good as soon as he was admitted to the hospital: he was short of breath and his lungs were buzzing. Considering that his illness has lasted for a week, the emergency doctor immediately gave the diagnosis of "staying in hospital for observation".

In less than a day, Michael's condition deteriorated rapidly and he was sent to EICU (Emergency Intensive Care Unit). The medical staff ventilated him with a large-flow humidification therapeutic instrument, strengthened the dilation and diuresis, and artificially ventilated him with a ventilator in the early morning of the next day. After non-invasive ventilator ventilation, anti-infection, anti-heart failure and other symptomatic treatment, the situation is still deteriorating.

At 7: 00 pm on April 7, the hospital quickly started the first round of multidisciplinary emergency consultation (MDT), and then transferred it to the extracardiac ICU for further diagnosis and treatment.

The experts who participated in the consultation carefully studied the condition, and everyone agreed that the root cause of his multiple organ failure was the heart, but the specific reason was not very clear. In order to protect the heart function, the expert group unanimously agreed to take active anti-infection treatment.

On April 10, he was transferred to CCU (Coronary Heart Disease Intensive Care Unit) for more targeted treatment. Doctors use "eighteen martial arts" including anti-infection therapy, ice blanket cooling, enhancing immunity, CRRT (continuous renal replacement therapy, also known as "bedside hemofiltration") dehydration to improve heart failure, correct electrolyte disorder, nutritional support, protect stomach and suppress acid.

Generally speaking, ordinary patients with heart failure will get better or at least stabilize after these high-level life support measures.

However, Michael is an exception. His condition is still deteriorating.

By the early morning of April 12, he had five organ dysfunction, uncontrolled infection, sepsis and septic shock, unstable blood pressure and sweating all over the body.

"The culprit": It is related to a rotten tooth.

On the morning of April 12, experts from cardiac surgery, cardiology, CCU, MICU, SICU, nephrology, gastroenterology, anesthesiology, cardiopulmonary bypass, ultrasound and other departments gathered at the bedside of CCU for the second MDT discussion. After MDT, 40 consultation experts continued to discuss Michael's treatment plan through WeChat group for a whole morning.

According to the results of imaging examination and family members, the patient has a dental caries and otitis media. The consultation of the dentist confirmed that he had a rotten tooth in his mouth, leaving only the root.

From the past experience, the expert group believes that infective endocarditis (abbreviated as infective endocarditis) is likely to be the chief culprit leading to the patient's serious condition.

Infectious endocarditis is a dangerous cardiovascular disease. Once the valve structure is damaged, the mortality rate of patients is as high as 30-50% without timely operation.

However, patients often have severe infection and acute heart failure from onset to diagnosis. If conventional medical treatment measures are ineffective, only emergency cardiopulmonary bypass can clear the infected focus, repair the affected valve structure and save the patient's life.

According to Xiong Mai, an associate professor of cardiothoracic surgery in the First Hospital of Sun Yat-sen, the main causes of infective endocarditis abroad are related to continuous hemodialysis treatment and intravenous drug addiction, but in China, due to the high incidence of dental caries and people's ignorance of oral health, infectious endocarditis caused by dental caries still accounts for a large proportion.

Play back the ultrasound image frame by frame, and finally find the surgical basis.

"His illness is so dangerous that it is a great challenge for us! Generally, heart failure patients are surgeons who ask physicians to operate as soon as possible, but this patient is the opposite. The physician suggested that we operate on him as soon as possible, but we felt that we must find the basis for the operation. " Professor Wu, director of cardiac surgery in the First Affiliated Hospital of Sun Yat-sen University, recalled that cardiac surgery had two foundations. One is that bacterial culture is positive, and the other is that cardiac imaging examination can find infected vegetation composed of platelets, fibrin, red blood cells, white blood cells and infectious pathogens on the surface of heart valves.

Unexpectedly, Michael gave the expert another big problem.

His bacterial culture results were negative, and it was impossible to determine the bacteria that caused the infection. "It is not surprising that we used vancomycin and other powerful antibiotics to fight infection, resulting in no positive results in bacterial culture, but in order to save his life, we can't stop taking drugs." Wu Shuo's only hope lies in the results of the image inspection.

Professor Wu, director of cardiac surgery in Zhongshan No.1 Hospital, and Professor Wu, deputy director of ultrasound department in Zhongshan No.1 Hospital, even tracked all bedside color Doppler echocardiography images of patients after admission.

"The shape and opening and closing of the patient's mitral valve have changed. But because of shortness of breath, the image taken is not very clear. At first, we couldn't find vegetation. " Professor Lin Hong said that after repeated inspections and rich experience, she finally found a floating vegetation at the tip of the valve, "very thin, you will miss it if you are not careful."

Director Wu immediately made a decision to perform mitral valve replacement (all mitral valve devices)+intracardiac foreign body removal+intra-aortic balloon counterpulsation catheter+open heart surgery assisted by cardiopulmonary bypass.

At this time, it's Friday night of April 12. From CCU, Anesthesiology Department, Cardiopulmonary Bypass Department, Operating Room, Blood Bank, Cardiothoracic Surgery ICU and other specialties, like gears on a chain, it runs quickly and efficiently. In just 1 hour, all aspects of preoperative preparation have been put in place.

At the same time, Michael gave the doctors another problem.

After examination, it was found that Micheal's blood was type B RH negative blood, also known as panda blood, which increased the difficulty of blood preparation. The blood transfusion department of the hospital quickly applied to Guangzhou Blood Center for blood transfer, which arranged for volunteers to donate blood.

At 8 o'clock in the evening, Wu took the lead and served as an assistant to start emergency surgery.

From the establishment of cardiopulmonary bypass to blocking the ascending aorta, the heart perfusion stopped and the heart cavity was opened. It was very quiet under the shadowless lamp in Room 28 of the first operating area, and only the monitor gave out the monitoring sound of "beep, beep". At this moment, time is life. During the cardiopulmonary bypass (CPB) under surgical anesthesia, everyone is focused on non-stop operation, and the tacit understanding accumulated at ordinary times does not need verbal reminder at this moment.

The operation is in progress.

During the operation, the doctor found a natural oval hole in Michael's atrial septum.

"The foramen ovale should be closed after birth, but he didn't." Wu explained that in some cases, blood from the right heart system and some infectious sources can enter the left atrium through this small hole, and then begin to destroy the mitral valve, which leads to the more severe progress of his disease than ordinary patients.

"I found the basis for diagnosis!" As soon as Wu opened the wall of the heart, he took a long breath, only to see the tiny vegetation that should not exist between Michael's mitral leaflets, and even "gnawed" off the chordae tendineae of the normal valve.

These vegetations are loose masses of bacteria, white blood cells and inflammatory tissues attached to the valve tissue, which will destroy the normal valve and even the myocardial structure.

Subsequently, the surgeon quickly removed the vegetation and destroyed the chordae tendineae of the valve leaflets, retaining the remaining healthy valve structure for artificial valve replacement. In less than 1 hour, the intracardiac operation was completed. With the ventilation and closure of the left atrium, the occlusion forceps at the aorta are opened.

Soon, the patient's heart started beating again.

Whole-course monitoring in cardiopulmonary bypass department and anesthesiology department.

Intraoperative ultrasound examination of esophageal probe showed that the original mitral regurgitation disappeared and the systolic function recovered. Because clear urine reappears in the urethra. The patient's condition has improved steadily.

You still need to prevent colds and oral diseases after the operation.

After the operation, Michael entered the intensive care unit of cardiothoracic surgery. After active anti-infection, improvement of cardiac function and protection of organ function, the left ventricular function recovered to normal level on the first day after operation, and the tracheal intubation was removed on the third day after operation. One week after operation (April 19), he recovered from extremely dangerous multiple organ failure and was transferred out of ICU smoothly.

I was admitted to the hospital for two weeks. After a narrow escape, I returned to the second ward of cardiac surgery, successfully embarked on the road of recovery, and was discharged today.

Professor Wu from the First Hospital of Zhongshan examined the patients.

"I feel very good now. That disease almost killed me! Before the operation, I had difficulty breathing and needed intubation, but now my breathing has recovered, I can speak normally and my heartbeat is normal. " Michael said, I am very grateful to the doctors for doing great surgery and giving me a new life. Before the operation, his weight was 105 kg, which was once reduced to 93 kg, and now it is back to 97 kg. The doctor reminded him to prevent the recurrence of his illness after discharge, beware of colds and fever, and pay attention to oral hygiene.

Talking about why the rescue was successful, Wu said that in addition to the strongest team from all disciplines in the hospital, trust and good communication between doctors and patients are also very important. "At every key point of this rescue, if the family members are hesitant and don't trust the doctor, then they will miss the opportunity of treatment."

Oral problems. Why?

Or is it related to heart disease?

Ordinary fever meets tooth decay.

Why did it turn into such a fierce situation?

What many people don't know is that periodontitis is closely related to heart diseases such as endocarditis. Periodontitis not only causes gingival inflammation, bleeding, periodontal pocket formation, alveolar bone absorption, tooth loosening and displacement, chewing weakness and so on. , but also closely related to endocarditis, myocardial infarction, coronary heart disease and so on.

Do you think periodontitis only hurts teeth?

What's even more frightening is:

The mouth of periodontitis patients contains a lot of bacterial toxins, just like a "bacterial storage base". If some bacterial toxins are allowed to enter the blood circulation system through the wound and enter other parts of the body, it will cause systemic diseases.

1. Increase the probability of heart disease. Periodontal disease is an important cause of premature tooth loss, which is secondary to other diseases. People with less than 2 1 teeth have a higher risk of heart disease than normal people. Patients with deep periodontal pockets (periodontal disease) have a 53% higher risk of heart attack.

Professor Huang from the Department of Stomatology, the First Affiliated Hospital of Sun Yat-sen University, said that when moderate and severe periodontitis occurs, a large number of pathogenic bacteria gather on the periodontal pocket wall, while the inflamed periodontal pocket epithelium becomes thinner or even ulcerated, and the permeability of the pocket wall is greatly enhanced, so a large number of bacteria and their toxic products enter the blood through the epithelium, so patients with periodontitis often have more serious bacteremia.

Bacteria and their toxic products cause wandering infection through blood, which leads to a series of pathological changes such as vascular endothelial cell disease, vasculitis, platelet aggregation and adhesion, vascular steatosis, cholesterol deposition, thrombosis, atherosclerosis and so on, thus affecting heart health.

Periodontal pathogens can be detected in coronary plaque and thrombus. Studies by scholars at home and abroad show that patients with acute myocardial infarction or coronary heart disease are more likely to suffer from periodontal disease than those without coronary heart disease of the same age and sex.

Professor Huang reminded that patients with heart disease should take the initiative to have regular oral examinations and actively prevent periodontitis. Periodontitis patients should also pay attention to unexplained fever and chest pain. In addition to regular tooth cleaning, patients with periodontal disease should also go to the periodontal clinic for follow-up visit every 3~6 months for basic periodontal treatment.

2. It is easy to cause abortion. The probability of premature delivery of pregnant women with periodontal disease is 7.5 times that of healthy pregnant women. Because periodontal disease will produce a substance, which will cause uterine contraction and lead to premature delivery.

3. Periodontitis can also aggravate diabetes. Pathogenic toxins and inflammatory factors in blood will reduce the sensitivity of insulin and affect blood sugar control.

4. cause stomach trouble. Dental plaque is the repository of Helicobacter pylori, which can cause chronic gastritis, gastric ulcer and even gastric cancer if swallowed in the stomach.

5. infertility. Oral bacteria invade the reproductive system with blood circulation, reducing sperm motility and causing male infertility.

6. Alzheimer's disease. Bacteria from gum disease invade the brain, which will lead to inflammation and brain damage.

Periodontal disease is so terrible, how to prevent it?

The symptoms of periodontal disease in the early and middle stages are not obvious, which makes many people take it lightly. Moreover, most people in China do not have the habit of regular oral examination, so it is difficult to find periodontal disease in the early stage and realize the problem until the teeth are loose.

Periodontal disease can be prevented by regular oral examination, good oral cleaning habits and regular tooth washing. Especially tooth washing.

Ultrasonic tooth cleaning

Cleaning teeth is a good means of dental care and an important measure to prevent periodontal disease. Regular tooth washing (adults should wash their teeth at least 1 2 times a year) can effectively prevent periodontal disease by removing calculus and plaque around the attached tooth surface!

Brush your teeth twice every morning and evening, remember not to forget!