TODAY’S BRACES

WHAT TO EXPECT, WHAT TO AVOID

(Courtesy of the ADA)

Before some dental treatments, patients who have certain heart conditions and those with artificial joints take antibiotics.  These people may be at risk of developing an infection in the heart or at the site of the artificial joint, respectively.  Antibiotics reduce this risk.   This is called antibiotic prophylaxis (pronounced pro-fuh-lax-iss).When treating patients with heart conditions, dentists follow guidelines developed by the American Heart Association (AHA), with input from the ADA. For patients who have total joint replacements, they refer to guidelines developed by the American Academy of Orthopedic Surgeons (AAOS).Guidelines for People with Heart ConditionsThe AHA guidelines are meant to reduce the risk of infective endocarditis (pronounced end-o-car-die-tiss). Infective endocarditis (IE) is an infection of the lining inside the heart or the heart valves. In the past, a number of heart conditions were thought to put patients at risk for IE.  When writing the new guidelines, the AHA looked at published research and other scientific articles.  They found that fewer conditions were associated with IE.  As a result, a smaller group of patients needs to premedicate before dental treatments.Why did the guidelines change? After looking at the published scientific reports and articles, the AHA concluded that: • the risks of adverse reactions to antibiotics outweigh the benefits of prophylaxis for most patients.  Adverse reactions can range from mild (rashes) to severe (breathing problems that could result in death). • when all the study results were looked at together, it wasn’t clear that premedication prevented IE.  • bacteria from the mouth can enter the bloodstream during daily activities like brushing or cleaning between the teeth. Once in the bloodstream, it can travel to the heart.  People at risk of infection might be more likely to develop IE from these activities than after a dental treatment.   • Also, bacteria that cause infections can become resistant to antibiotics if those drugs are used too often.  Because of this, doctors try to limit the use of antibiotics.Patient selectionThe current guidelines recommend use of preventive antibiotics before certain dental procedures for people with: • artificial heart valves • a history of infective endocarditis • a cardiac transplant that develops a heart valve problem • the following congenital (present from birth) heart conditions:* ◦ unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits ◦ a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure ◦ any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device* Check with your cardiologist if you’re not sure whether or not you fall into one of these categories. • People who took prophylactic antibiotics in the past but no longer need them include those with: • mitral valve prolapse  • rheumatic heart disease • bicuspid valve disease • calcified aortic stenosis • congenital (present from birth) heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.Talk to your dentist about how these guidelines might apply to you.Additional resources • American Heart Association downloadable wallet card (available in English and Spanish) • For the Dental Patient: Antibiotics and Your Heart
Guidelines for People with Total Joint ReplacementsGuidelines from the AAOS are meant to reduce the risk of infections at the site of an artificial joint.  They apply to people who have total joint replacements.  Patients who have pins, plates or other orthopedic hardware are not affected.AAOS recommends that all patients who have total joint replacements should take antibiotics before certain types of dental procedures. Talk to your dentist about how these guidelines might apply to you.

(Courtesy of the ADA)

INTELIHEALTH – People who visit the dentist regularly have better oral health, an 18-year study has found.

Most studies that look at the benefit of regular dental visits are called cross-sectional studies. They ask people one time about how often they visit the dentist and when they last visited. This study kept track of the same 932 people, starting at age 15. At that age, 82% had received dental check-ups and visited the dentist in the last year.

Researchers asked about dental visits at ages 18, 26 and 32. By the time the people in the study were 32 years old, only 28% had visited the dentist in the last year.

At any of these ages (15, 18, 26 and 32), people with regular dental visits had:

• Fewer missing teeth in general
• Fewer missing teeth because of decay
• Less decay
• Fewer fillings

The longer people kept up regular dental visits, the more likely they were to have good oral health.

The study was done by researchers at the University of Otago in Dunedin, New Zealand. It was published in the March issue of the Journal of Dental Research.

INTELIHEALTH – People who are given oral health care plans after surgery for oral cancer are less likely to get infections, a study has found.

The study followed 66 people in Japan. All had surgery for oral squamous cell carcinoma. This type of cancer affects about 30,000 Americans each year.

Half of the people in the study were given a plan for oral hygiene. The other half were not.

About 9% of the oral-hygiene group had an infection at the surgical site. About 33% of the other group who received no oral hygiene instructions had this kind of infection. These infections are the most common complication after surgery for oral cancer.

The researchers looked at 23 possible factors that might be linked with the infections. They found two of those factors increased risk for infections in the study group. They were having a tissue transplant during surgery, and poor personal oral health care.

A tissue transplant replaces diseased tissue removed during surgery. Having a transplant increased the risk of infection by more than 24-fold. Poor personal oral health care increased the risk 6-fold.

The study appears in the March 16 issue of the journal Supportive Care in Cancer. The researchers are from Hokkaido University in Sapporo, Japan.