Riverwalk Dental

Riverwalk Dental’s antibiotic prophylaxis protocol and explanations.

 

Since we discussed joint prophylaxis for our dental patients last week, a number of you have asked us about taking antibiotics for your heart condition. Things have changed in the last ten years or so, so we thought to get everyone up to date. The good news is that the guidelines have gotten much clearer the past several years, and many people no longer need prophylaxis.

What’s the Big Deal?

The underlying concern is that certain dental procedures can cause a small amount of bleeding, and that this could open an avenue for mouth bacteria to get into the bloodstream and potentially cause damage. The idea for the use of antibiotics is that if the antibiotics are already present in the bloodstream at a high enough concentration when bacteria enter, they will destroy the bacteria and prevent complications.

Historically, antibiotics have been given for a very wide range of conditions, even without sound scientific rationale. Over the past 10-15 years, as the problems of bacterial resistance and overuse of antibiotics have come to the surface, as well as increasing awareness of the allergic risk of some antibiotics, these recommendations have been updated to target the patients most at risk for complications.

OK, Who is At Risk?

In the patient with cardiac disease, the concern has been that bacteria floating in the bloodstream could attach themselves to the valves of the heart (almost like barnacles on ships), especially if there is already a problem with the valves that prevents normal smooth blow flow. This could build up, altering blood flow and causing an infection of the actual heart, called infective endocarditis. Complications of this infection can include heart attack, stroke, or even death.

What Signs & Symptoms are There?

 

In infective endocarditis of the heart caused by dental bacteria, there is often a slow subtle onset. The most common sign is a fever, often anywhere from a couple of days to a couple weeks. You may also experience a cough, joint pain, diarrhea and trouble breathing. Occasionally you may see red streaks under the fingernails or on the soles of the feet. It is not uncommon, however, to not recognize anything at all beyond a vague fever.

 

How Do we Diagnose This?

 

The most important method of diagnosing infective endocarditis is with blood cultures (finding the bacteria in your blood). Other criteria are necessary, such as an echocardiograph (ultrasound of the heart), to look for bacterial buildup, along with certain other signs and symptoms.

 

 

How Is This Treated?

 

When a diagnosis of infective endocarditis of the heart is made, treatment is centered largely around IV antibiotics (directly into the blood stream), often for 4 or more weeks.  This will often be done with the help of an infectious disease doctor, along with a cardiologist. Treatment can become more complex if any complications of endocarditis are evident, such as a heart attack, heart failure, or a stroke.

 

 

So, Who Needs Prophylaxis Now?

The American Dental Association, along with the American Heart Association, updated their recommendations for routine prophylaxis against infective endocarditis. Currently, patients with prosthetic valves, previous infections and certain specific congenital disorders are required to take prophylaxis. Many patients are no longer affected, such as patients with mitral valve prolapse or mitral valve prolapse with regurgitation. We have found that the risk of infection is actually lower than the risk associated with taking the antibiotics. We have also found that only a handful of cases of infective endocarditis is actually caused by oral bacteria yearly.Cardiac Prophylaxis

As far as what procedures require prophylaxis, the answer is that anything that can cause any bleeding at all. So, for instance, you’ll want to take your medicine prior to a cleaning or root canal, or a surgical procedure such as an extraction, dental implant, or gum surgery. However, for routine fillings, impressions and x-rays, prophylaxis is not needed. You’ll want to talk with us to make sure to get the correct recommendations.

 

What Can I Do?

 

The best way to minimize risk of getting endocarditis, or having your mouth be the source of infection elsewhere in your body is to maximize the health of your mouth. Make sure you are routinely brushing and flossing, at least twice daily. Make sure you see us for regular checkups twice yearly, or more frequently if you have gum disease.

If you currently take antibiotics prior to routine dental care, and have not reviewed your reasons with us and your physician for several years, you may want to bring this up with us prior to your next appointment. You may no longer need to take medication.

If there have been major changes to your health, and you are concerned that you may require medication, please feel free to contact us and also review with your physician.

Working together, we can make sure to follow the latest recommendations and keep you safe.

 

Sincerely,

Drs. Beninato and Patsi

Riverwalk Dental- Protecting your joints!

Joint

 

We recently had a patient  come in who had forgotten to take his necessary antibiotics prior to his cleaning, and needed to reschedule. When we told him, he said he simply forgot, but it was clear that he didn’t understand why he took them.

The underlying concern is that certain mouth bacteria can get into the bloodstream and latch onto the artificial joint, causing infection. This can be extremely serious, needing anything from long-term antibiotics to removal of the infected joint, and can even be fatal.

Because of this fear, antibiotics have been prescribed to be taken prior to having dental appointments that can cause bleeding. The idea for the use of antibiotics is that if the antibiotics are already present in the bloodstream at a high enough concentration when bacteria enter, they will destroy the bacteria and prevent complications.

Of course, avoiding your mouth can be an even bigger problem, as things like active gum disease cause bleeding and entry of potentially dangerous bacteria into the bloodstream continually. The best course of action is a clean mouth, with good home care and professional treatment with us.

Antibiotics used to be given for lifetime prophylaxis, but things have changed over the past ten years. We have realized that the risks of infection are not as high as we once thought. Also, we now realize that taking antibiotics have their own risks, such as allergies and growing bacterial resistance.

For patients who have prosthetic joint replacements, the joint recommendations of the American Dental Society and the American Association of Orthopedic Surgeons recommends routine prophylaxis for two years following insertion of the prosthesis. This should be extended if there have been previous infections, or if the patient is immunocompromised, has cancer, is malnourished, or has inflammatory arthritis or diabetes. These recommendations also have more variables, so it is best to discuss your particular case with us as well as your orthopedic surgeon to get individualized recommendations.

 

As far as what procedures require prophylaxis, the answer is that anything that can cause any bleeding at all. So, for instance, you’ll want to take your medicine prior to a cleaning or root canal, or a surgical procedure such as an extraction, dental implant, or gum surgery. However, for routine fillings, impressions and x-rays, prophylaxis is not needed. You’ll want to talk with us to make sure to get the correct recommendations.

 

So, what can I do?

 

The best way to minimize risk is to maximize the health of your mouth. Make sure you are routinely brushing and flossing, at least twice daily. Make sure you see us for regular checkups twice yearly, or more frequently if you have gum disease.

If you currently take antibiotics prior to routine dental care, and have not reviewed your reasons with us and your physician for several years, you may want to bring this up with us prior to your next appointment. You may no longer need to take medication.

If there have been major changes to your health, and you are concerned that you may require medication, please feel free to contact us and also review with your physician.

Working together, we can make sure to follow the latest recommendations and keep you safe.

 

Drs. Beninato and Patsi

Riverwalk Dental virtual tour…

Have you seen our practice lately?

IMG_4103

 

Make sure to come by for a tour!  We would be more than happy to show you around our state-of-the art facility and we are sure you’ll enjoy the views as much as we do!!!

Riverwalk Dental Operatory view!

 

Our practice has been in this location in Lawrence, MA since 2008.  We strive to offer a welcoming, comfortable and stress-free environment for all your dental needs.

Front Desk area

 

These some pictures of our wonderful office.  Enjoy!

Welcome to Riverwalk Dental’s blog!

We would like to extend a warm welcome to all our patients coming to our website.

On here, you’ll find information regarding our dental practice, our philosophy of treatment and a lot of information regarding common dental problems along with explanations of certain dental/medical diseases.  We will try to explain the connection between what happens in the mouth and the rest of the body and how the two correlate.

This is meant to be an interactive platform.  If you have any general questions we would be more than happy to assist you in answering your questions, but if there are more specific issues, please make an appointment and we would be more than happy to assist you and answer all your questions face to face.

As always, our staff and Drs. Beninato and Patsi can be reached at 978-685-1499.

Feel free to contact us at any time.  Come back frequently in this little corner of the web and we are sure you’ll find a lot of useful information on our blog.

And don’t forget, you can “Like” us on Facebook at Riverwalk Dental P.C. and you can follow us on Instagram at RiverwalkDentalPC.

 

Glad to see you here.

 

Drs. Beninato and Patsi

Riverwalk Dental morning view!

Riverwalk Dental morning view!

Tags: ,

Why Riverwalk Dental is your family’s choice for dental care

When you visit Riverwalk Dental at our office in Lawrence Massachusetts, you will find that Dr. Beninato and Dr. Patsi are committed to making your experience the most comfortable it can be.  We understand that doctor visits in general can be stressful, but it does not have to be that way.  With years of experience and only the newest technology designed to ensure a positive experience, all members of your family will find peace of mind each time the visit our office.