PRE-MEDICATE BEFORE DENTAL PROCEDURES

mtks

I just thought I'd pass on this information to all of you with breast implants.

You must be PRE-MEDICATED before any dental cleaning or extensive dental work, such as extraction, crown preps, root canal therapy,ect.

Your Dentist will give you the RX.

poolas

mtks

Why do you need the pre-medication?  i am schduled for deep clean in a couple of months and the Dentist did not mention this.

Thank you

Paula

weety

I was given a prescription for antibiotics before dental work as a precaution, but that was because I was only a month or two out of chemo and still on herceptin.  My blood counts were still pretty low.  Is that what kind of premedication you are talking about?

sas-schatzi

MTKS--------please identify peer reviewed journal articles and evidenced based research that supports this position.  Thank you

peggy_j

Some people have other health issues (heart conditions, etc) that require them to take certain meds before dental procedures, even cleanings (during a cleaning, plaque can get into the blood steam and make it to the heart).   My dental hygienist always asks for changes in health history at the start of the visit, but it never hurts to mention it beforehand.

ICanDoThis

I get prophylactic antibiotics before cleanings, as I have a knee replacement.

Makes sense, I guess that breast implants could be the same. Evidently, dental cleanings introduce a potload of bacteria into your bloodstream.

sas-schatzi

ICDT------people with metal implants are premedicated. But breast implants are silastic. 

The heart conditions vary and the American heart Association has changed their policy on what conditions need premed over the years.

That's why I asked for the evidence based research supporting this therapy. Weety has a legitimate reason for premed b/c counts were low------the specific count that would be of concern would be the Neutrophil and WBC count.

MTKS-------if you have the research for this please post, if it came from your dentist please ask them for their source so that you can post it here and we can then review ourselves and take it to our doc's for discussion. Thanks  much It's not that I don't trust what you say, but all actions like this must be based on current research. For some taking an antibx is a big issue.

mtks

I'll be happy to ask my PS. He is the one that told me. I did not ask for info on it, I just took his word for it and my dentist confirmed it.

sheila888

I had major dental work about 3 years ago.

Dentist called my Oncologist and no I wasn't pre-medicated.

Sheila

otter

I just googled the issue, and it's very controversial.  Try "breast implant" x "dental" x "antibiotics", and you'll see.   I'll list some websites in a moment.

According to one of the sites I found, "the bottom line is that there is no bottom line."

SAS is correct -- the recommendations for prophylactic antibiotics prior to dental work changed a few years ago.  Hardly anyone is supposed to need prophylactic antibiotics anymore.  I have a floppy mitral valve, and I was told many years ago by my PCP and my dentist that I would need antibiotics before dental work.  So I was given a high dose of ampicillin before each of my regular dental cleanings, as well as before any more invasive work. 

About 4 years ago, though, some evidence came out showing that people with minor heart problems who did not take prophylactic antibiotics were no more likely to develop endocarditis after dental work than people who did take antibiotics.  And, it turns out, there are as many oral bacteria released into the blood ("showering") with an aggressive flossing than with a routine dental cleaning.  So we're putting ourselves at risk as often when we floss as when we go to the dentist for a regular checkup.  My PCP and my dentist now both say there is no need for antibiotics (although they did defer to each other when I asked).

Some plastic surgeons are still recommending prophylactic antibiotics, while others are not.  One of the dental sites I found said the dentist should not be responsible for writing the prescriptions anymore.  If a physician thinks his/her patient is at risk of endocarditis as a result of dental work, then that physician should write the prescription.   Those could be cardiologists (heart valve replacement), orthopedic surgeons (joint replacement surgery), or, in this case, especially cautious reconstructive surgeons.

One situation in which a cancer patient might need to premedicate with antibiotics is if she is still immunosuppressed from chemo, or if the cancer has invaded the bone marrow or otherwise affected the person's immune system.  In that case, an oncologist would probably write the prescription.

Here are some web citations and one citation from the refereed research literature.

A recent (Sept. 2010) and good discussion of the issue by a dentist:  http://www.oralanswers.com/2010/09/dentistry-antibiotic-premedication-prophylaxis/

A Nov. 2009 discussion of the issue among dental hygienists:  http://www.rdhmag.com/index/display/article-display/371455/articles/rdh/volume-29/issue-11/columns/staff-rx/prescribing-antibiotics.html

An April 2011 blog entry from a plastic surgeon in Florida:  http://www.plasticsurgeryfl.com/blog/bid/45935/Antibiotic-Prophylasis-for-Breast-Implants-Is-It-Necessary

A 2007 research paper in the Journal of the American Dental Association:  http://jada.ada.org/content/138/4/458.full  (This may be the definitive paper on which my PCP and dentist based their new advice.)

Good luck figuring this out!

otter

Sherryc

I have metal plates and screws in my neck and have had some major dental work done and my dentist has never put me on antibiotics beforehand.

sas-schatzi

Otter-----bless you. Your answer is so thorough . I used to love research, but the brain doesn't work the way it used too and sometimes I'm just lazy. It will take awhile to get through the reading, but you covered all the bases. I know who to come to now when I need help.

The reason for antibx's with metal, is if a systemic infection occurs  a bio-film can form on the metal. Once that occurs it is very difficult to eradicate b/c the film is for lack of a better analogy is sticky on the metal. So, Sherry what would be a nice addition to this section is to ask your doc why you haven't been prescribed antibx's. He then would enlighten you, and then you could enlighten us. Routinely, those with total hips and total knees or partial of either are medicated, Why not you? Very good question.

I'm in a typical insomniac shape right now. So, I'll share two of my son's science projects with you. The original question was mine, but he did all the work and ribboned with each project. He did the research under the supervision of the head medical technologist at a local medical center. It was publishable, but couldn't get him to do it. I think I will go and find it on another thread that I wrote it on rather than rewrite. So, I''ll be back when I find it.

Otter thanks again

 Well found the post from a year ago. Hope someone finds it useful and enjoys the humor of my OCD.

sas-schatzi

Jul 22, 2010 08:08 pm, edited Jul 22, 2010 08:28 PM by sas-schatzi sas-schatzi wrote:

This is for Everyone. Years ago I suggested for my sons sceince research project that he test tooth brushes and see if washing them in the dishwasher had any effect. He was able to work in the micro lab at the hospital I was working at. He ribboned well. His results were publishable, but he wouldn't take it to that next step.

Process--cultured all new tooth brushes to assure they carried no bacteria in the beginning. Each participant used their toothbrush for one week Placed in a sterile bag and each was recultured. The wide range of bacteria was amazing. Ranged from normal flora (Streptococcus Veridans is a normal colonized bacteria in the mouth) to pseudomonas A. (bad bug-can't spell it). Then each used their brush daily and washed in the dishwasher each day for a week. At the end of the week, each brush was placed in a sterile bag after dishwasher and recultured at the lab. All brushes that had gone through the dishwasher were 100% free of bacteria. He repeated the whole process three x's which is a requirement of the sceintific method for validating results. Next sceince project, he cultured the participants mouths at the beginning of the week and each washed with a brush from the dishwasher each day for a week. At the end of one week, each participants mouth was recultured to see if it reduced the bacteria in the mouth. Again repeated for three x's.  It did reduced bacteria documented for each participant at initial culture . He ribboned well in that year also. 

So, how do we use it?  We use each brush once, it's put in a different container, which then goes to the dishwasher when the containers partly full or full.  When someone goes into our bathroom there's 14 brushes (I just counted) for two people LOL.

Randoms facts about the mouth and toothbrushes: The average use of a toothbrush is 6 months- range 3-9 months. The average toothbrush is never washed except for rinsing under running water. Streptococcus Veridans causes tooth decay. If a persons mouth is not colonized by 18 months of age(I think my memory is correct on that one as to time), they will not become colonized. When a WOUND culture comes back with strep veridans, it's from someone mouth i.e spray from talking over an open wound.

His projects were done prior to 2003, so, some info may have changed

I have just succeeded in making you as crazy as I am because you will not be able to look at your toothbrush in the same way again.LOL  Does anyone recognize OCD symptoms here? LOL

It is actually good info for anyone going through chemo because of the associated risk of mouth sores during  lowered immunity.

cycle-path

Thanks, SAS! Very interesting!

One other cleaning thing that many people never wash is the sponge at the kitchen sink. (I put mine through the dishwasher whenever I remember but none of the other household members are trained yet.) Sponges become full of nasty beasties very quickly, but we blithely use them to "clean" other items in the food preparation area! Kinda scarey if you think about it.

otter

Wow, SAS.  I just bought 4 toothbrushes at Winn-Dixie yesterday.  They're the kind I like to use and have been looking for (unsuccessfully) for a year.  I bought the store's entire supply of that type of toothbrush.  (heh heh)

Now I'm wondering something... does really frequent replacement of toothbrushes, or disinfection in the dishwasher, result in fewer cavities (dental caries)?  Or, are those S. veridans there for good and the bacteria on the toothbrush don't add to the burden?

otter

sas-schatzi

Otter -----definitely some research projects in your questions.The one project did show that all bacteria in the mouth  in the three weeks of testing was reduced.  At one time I sent a semblance of the above description to the CDC. The response was that there was no published research on the subject and that putting the toothbrush in the dishwasher might make the toothbrush not last as long as usual------------------LOL> I couldn't believe the responding person cared about the longevity of the brush versus a positive impact of reducing bacteria-----DUH. I so wish DS would have submitted his research for publication Bummer.

Besides fewer cavities , would there be a difference in other illnesses whose vectors  pass through the mouth?

CyclePath   I agree, the scratch pads and cleaning brushes go in with every wash.  Are we just real aware or OCD,  LOL

Annabella58

in teresting thread, ladies.

I went to sloan Kettering for answers...bs and ps and onc. all say "no, no need unless you have pre existing heart condition or mitral valve or joint replacement issue."

Dentist confirmed...in fact, all drs. looked at me like I was nuts.

Hope that helps.

I microwave my sponge daily and always sterilize toothbrush weekly, as well as replace on monthly basis.

Anonymous

My PS wants me on antibiotics for every dental visit soley because of the implants .  I'm leaning towards not complying.  That would mean I would be on a course of antibiotics a minimum of twice per year (cleanings) ~ god forbid I need a crown which requires several visits!  Thanks otter, for the research too.

So I would assume even some breast augmentation patients are being told this? 

And first thing I'm going to do when I get home is stick our toothbrushes in a bleach solution!! (We have the sonicare so can't put them in the dishwasher.  

apple

love the sonic care toothbrush.. I bleach our toothbrushes regularly.. (not full strength),, and put a lot of things thru the dishwasher altho presently there is no room for anything but dishes.. so I put sponges thru the clothes washer on the bleach load.

My onc. told me 'no dental work while you are xeloda.. you might be prone to bleeding.. but just call me and I'll talk to your dentist... how's that for helpful?  I love that onc.

ICanDoThis

SusansGarden -  

My dentist doesn't give me a whole course of antibiotics - just one pill several hours before cleaning.

Anonymous

Interesting, Sue.  I saw that mentioned somewhere else too.  I'll have to look into that.

sas-schatzi

I had an augmentation in 1980 and was never told to permed, Of course may have not told some dentists either. 

Anniealso--------It's only certain heart things like pig valve I believe. I used tobe an ACLS and BLS instructor. Our statndard comment regarding the American Heart Association was "what are we teaching this year" LOL. 

I think it's good we get this info out re: toothbrush care. You wouldn't believe some of the bugs DS cultured. One person had pseudomonas on their brush UGH, bad bug. 

Annabella58

ugh, I agree....new toothbrushes ev. month for our household!

I don't even like to keep them in the bathroom!

I think you are right on the pig valve thing.  I did ask my dentist (endodontist, actually, as I was having a root canal) and he said it's CYA thing that many dentists do.  Not necessary, as he gave a detailed explanation of why the bacteria cannot get out.  It is contained within the tooth and the roots are cauterized.  It would be a very long shot, but again, it's a litigious society we live in.

Yes, he had some augmentation patients requests antibiotics.  I requested them from him, but he said no.  So did my GP.

Still makes me a bit nervous, but since spontaneous loss of implants from dental procedures is a myth, according to my onc, then I guess I'm OK.

Isabella4

I've just had several teeth extracted...with much drama, I might add!!!! and my dentist, and doctor both point blank refused to give me antibiotics.

I have a diseased aortic valve, so what to do ?? Pick up the 'phone and ring the vet. for antibiotics for my Rottweiler. Now half way thru' a course of penicillin. This is UK. We have a third world country approach to medicine.

Isabella.

thenewme

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