Posts for: September, 2019
Office cleanings and other minor procedures are a routine part of regular dental care. For some people, though, a routine visit could put them at slight risk for a serious illness.
The reason for this concern is a condition known as bacteremia. This occurs when bacteria, in this case from the mouth and conceivably during an office cleaning or other routine dental procedure, enters the bloodstream. Although for most people this isn’t a great issue, there’s been concern that bacteremia could further compromise the health of patients with or susceptible to other conditions like endocarditis (heart inflammation), prosthetic joints or compromised immune systems.
This concern grew out of a number of studies in the early 20th Century that seemed to show a link between dental bacteremia and infective endocarditis. At about mid-century it became a common practice to administer antibiotics before dental work (usually 2 grams of amoxicillin or an equivalent about an hour before) to high risk patients as a way of protecting them against infection. The practice later expanded to other health issues, including many heart conditions.
Beginning in 2007, however, guidelines developed jointly by the American Heart Association and the American Dental Association reduced the number of conditions recommended for antibiotic therapy. Based on these guidelines, we now recommend pre-procedure antibiotics if you have a history of infective endocarditis, artificial heart valves, certain repaired congenital heart defects, or heart transplant that develops a subsequent heart valve problem. Patients with prosthetic joints or immune system problems are no longer under the guidelines, but may still undergo antibiotic therapy if believed necessary by their individual physician.
If you have a condition that could qualify for antibiotic therapy, please be sure to discuss it with both your dentist and physician. We’ll work together to ensure any dental work you undergo won’t have an adverse effect on the rest of your health.
If you would like more information on antibiotic therapy and dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Antibiotics for Dental Visits.”
Although cancer treatment has advanced steadily in recent decades, the most used therapies continue to be radiation and chemotherapy to eradicate cancerous cells. And while they often work, both can cause "collateral damage" in healthy tissues near the targeted cells.
This can create a number of indirect consequences for a patient's health, including in the mouth. The salivary glands, for example, can be damaged by radiation treatments aimed at the head or neck. The effect on these glands can interrupt the normal flow of saliva and cause xerostomia or "dry mouth."
Lack of adequate saliva causes more than an unpleasant, sticky mouth feeling. One of saliva's main functions is to neutralize acid that builds up naturally after eating. Without it, high acid levels can cause enamel and root surface erosion and lead to tooth decay.
Cancer treatment can also contribute to gastro-esophageal reflux disease (GERD). This disease causes stomach acid to bypass the natural tissue barriers of the esophagus and enter the mouth. As with dry mouth, the increased acid level from GERD can be just as devastating to enamel—and the damage will be permanent.
To minimize these effects on your dental health, it's important to take proactive steps before, during and after cancer treatment. If at all possible, have any needed dental work performed before you begin radiation or chemotherapy—it's better to start it with teeth and gums as healthy as possible.
During treatment, try to continue regular dental visits to monitor your oral health and receive any needed preventive or therapeutic treatments. Depending on your condition and the advice of your dentist, you may need to increase your visit frequency during this time. Your dentist can help with boosting your saliva production and strengthening your tooth enamel. But you should also practice daily brushing and flossing, drink plenty of water and seek treatment for any resulting GERD symptoms.
Even with the best efforts, though, your teeth and gums may still incur damage while treating your cancer. Fortunately, there are a wide array of materials and procedures that can effectively restore them to health. So, once your treatments are completed consult with a dentist on your options for improving the health and appearance of your teeth and gums.
In our constant battle against infectious disease, the “enemy” is often too close for comfort: hospitals and other medical facilities must be ever vigilant against opportunistic infections their patients may contract while in their care.
Dental offices are no exception. Because even the simplest procedure — a dental cleaning, for example — may result in exposure, providers and patients alike face a possible health risk. We must be especially concerned with blood-borne viral infections — spread by person to person contact through blood — the most serious being hepatitis B and C, and HIV/AIDS.
Hepatitis is a viral inflammatory disease that disrupts the critical functions of the liver, particularly as it cleanses and regulates the blood, and cause serious bodily impairment or death. The virus can be transmitted when the blood from an infected person makes its way into the bloodstream of another person, mainly through cuts or a needle injection. Human immunodeficiency virus (HIV) can lead to the chronic condition AIDS that destroys the body’s immune system; it spreads mainly through sexual contact, as well as through person to person blood contact.
The best defense against the spread of these diseases in dental offices or other healthcare settings is to eliminate as much as possible any opportunity for blood-to-blood contact. To accomplish this, all healthcare providers, including dentists, are mandated by federal, state and local authorities to incorporate and follow routine safety precautions. The U.S. Center for Disease Control and Prevention (CDC) issues regularly updated comprehensive guidelines for protocols and procedures to disinfect and sterilize equipment and facilities.
We dentists and our clinical staffs are also mandated by state licensing boards to refresh our knowledge of infection control procedures through continuing education. Such procedures cover every aspect of infection control, from barrier protection — by way of gloves, masks or gowns — to instrument disinfection.
Protecting patients as well as providers from the spread of infection is one of our profession’s highest standards. As a result, incidents of infection among the 170,000 practicing dentists in the United States are rare. You can be assured, then, that we’re taking every precaution to keep you and your family safe from disease when you visit our office.
If you would like more information on dental office procedures to prevent the spread of infection, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Infection Control in the Dental Office.”