Posts for: July, 2018
Many people have questions about the proper use of antibiotics — especially today, as the overuse of these medications has become a concern. It isn’t necessary for most people to take antibiotics before having a dental procedure. But for a few — notably, those with particular heart conditions and, in some cases, joint replacements — pre-medication is advisable. The question may be even more confusing now, because the standard recommendations have recently changed — so let’s try and sort things out.
First, why would anyone need antibiotics before dental treatment? Essentially, it’s because of the chance that an open wound could allow bacteria from the mouth to enter the bloodstream. For people in good health, the body is capable of quickly containing and neutralizing the bacterial exposure. But people with some types of heart disease, heart transplants, and/or total joint replacements have a greater likelihood of developing a bacterial infection, which can be dangerous — or even life-threatening. The same may be true of people whose immune systems are compromised.
At one time, people with a broad range of heart problems and artificial joints were advised to pre-medicate; today, new research indicates that fewer people need to take this step. Antibiotics are currently recommended before dental procedures if you have:
- An artificial heart valve, or a heart valve repaired with artificial material
- A history of endocarditis
- A heart transplant with abnormal heart valve function
- Cyanotic congenital heart disease (a birth defect where blood oxygen levels are lower than normal) that hasn’t been fully repaired — including children with surgical shunts and conduits
- A congenital heart defect that has been completely repaired with artificial material or with a device — but only for the first six months after the repair procedure
- Repaired congenital heart disease with residual defects, such as leakage or abnormal flow
In addition, not everyone who has an artificial joint needs antibiotic premedication. Instead, your health care providers will rely on your individual medical history to determine whether this step is required in your situation. However, having a compromised immune system (due to diabetes, cancer, arthritis, chemotherapy and other factors) is still an indication that antibiotics may be needed.
The question of whether or not to pre-medicate is an important one — so it’s vital that you share all relevant medical information with your doctors and dentists, and make sure everyone is in the loop. That way, the best decisions can be made regarding your treatment.
Fans of the legendary rock band Steely Dan received some sad news a few months ago: Co-founder Walter Becker died unexpectedly at the age of 67. The cause of his death was an aggressive form of esophageal cancer. This disease, which is related to oral cancer, may not get as much attention as some others. Yet Becker's name is the latest addition to the list of well-known people whose lives it has cut short—including actor Humphrey Bogart, writer Christopher Hitchens, and TV personality Richard Dawson.
As its name implies, esophageal cancer affects the esophagus: the long, hollow tube that joins the throat to the stomach. Solid and liquid foods taken into the mouth pass through this tube on their way through the digestive system. Worldwide, it is the sixth most common cause of cancer deaths.
Like oral cancer, esophageal cancer generally does not produce obvious symptoms in its early stages. As a result, by the time these diseases are discovered, both types of cancer are most often in their later stages, and often prove difficult to treat successfully. Another similarity is that dentists can play an important role in oral and esophageal cancer detection.
Many people see dentists more often than any other health care professionals—at recommended twice-yearly checkups, for example. During routine examinations, we check the mouth, tongue, neck and throat for possible signs of oral cancer. These may include lumps, swellings, discolorations, and other abnormalities—which, fortunately, are most often harmless. Other symptoms, including persistent coughing or hoarseness, difficulty swallowing, and unexplained weight loss, are common to both oral and esophageal cancer. Chest pain, worsening heartburn or indigestion and gastroesophageal reflux disease (GERD) can also alert us to the possibility of esophageal cancer.
Cancer may be a scary subject—but early detection and treatment can offer many people the best possible outcome. If you have questions about oral or esophageal cancer, call our office or schedule a consultation. You can learn more in the Dear Doctor magazine article “Oral Cancer.”
Millions of Americans regularly use ibuprofen to manage minor pain and swelling. As with other fields in healthcare, the drug is a mainstay in dentistry especially for post-procedural discomfort. But ibuprofen and similar drugs also have side effects that can lead to serious health problems. So, should you be concerned about its safety?
For most people, ibuprofen is safe and effective — but only if used properly. Like aspirin, ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that reduces pain and inflammation by blocking the effect of substances called prostaglandins, released by injured or damaged tissues. NSAIDs differ in mechanism from pain relievers like steroids or narcotics and don’t have the same side effects, especially the addictive qualities and impaired consciousness potential of narcotics like morphine or codeine. While these more potent drugs are usually reserved for serious injuries or illnesses, NSAIDs like ibuprofen are ideal for mild to moderate pain following routine dental work.
The biggest concern for the use of an NSAID is its tendency to thin the blood, especially if used continuously over several weeks; this can make bleeding control more difficult after an injury. Prolonged overuse has also been linked to erosion of the stomach lining leading to ulcers or bleeding, kidney failure, early miscarriage and repeat heart attacks for patients with cardiovascular disease.
With this in mind, we recommend that adults take no more than 2,400 milligrams of ibuprofen during one twenty-four hour period for short-term pain relief unless otherwise recommended by a doctor. Research has shown that a single 400-milligram dose of ibuprofen is safe and effective for relieving even severe post-operative pain for about five hours in most people. On the other hand, we don’t recommend a NSAID during pregnancy or for people with a history of intestinal bleeding or heart attacks.
Taking into account your medical history and the procedure you’ll be undergoing, we will recommend the best pain management medication for your situation. In most cases, ibuprofen will be an effective means to reduce your discomfort level and, taken properly, will not pose a danger to your overall health.
If you would like more information on dental pain management, 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 “Treating Pain with Ibuprofen.”