Article Text

Download PDFPDF
Streptococcus mitis infective endocarditis in a patient with ventricular septal defect and orthodontic appliances
  1. Dimitrios Amorgianos1,
  2. Hui Min Chen2 and
  3. Niki Walker3
  1. 1Cardiology Department, NHS Shetland, Lerwick, UK
  2. 2South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
  3. 3Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
  1. Correspondence to Dr Dimitrios Amorgianos; d.amorgianos{at}


We describe a case of a girl in a remote and rural location in Scotland with a perimembranous ventricular septal defect and orthodontic appliances, who developed right-sided infective endocarditis from Streptococcus mitis due to abrasion of the oral mucosa from the arch wire following its adjustment in the dental clinic.

Fitting and adjustment of orthodontic appliances are not considered to be high-risk dental procedures and antibiotic prophylaxis is not recommended even for patients at highest risk for infective endocarditis.

  • cardiothoracic surgery
  • valvar diseases

Statistics from


  • Contributors DA and HMC were the treating doctors in the rural hospital. They wrote the case report and contributed figures 1 and 2. NW was the treating doctor in the tertiary hospital. She reviewed the case report and contributed figure 3 and video 1.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.