An Interview with Dr. Karagiorgos on Antibiotic Prophylaxis

Jul 30, 2019

Antibiotic prophy….say what?! For most of our patients, antibiotic prophylaxis is something they’ve never heard of and don’t need to worry about.  However, for some of our patients, particularly with heart conditions, it can be an important part of their oral health care. In short, antibiotic prophylaxis is the use of antibiotics before a dental procedure to prevent a bacterial infection elsewhere in the body.  It is a treatment that may be recommended for you after talking with your physician and Dr. Brunacini or Dr. Karagiorgos. There are side-effects and risks to taking antibiotics, so antibiotic prophylaxis is only used when the benefit outweighs the risk for you. To learn more, we talked with Dr. Karagiorgos.

1. What is Antibiotic Prophylaxis?

Dr. Karagiorgos:  Antibiotics usually treat bacterial infections, but sometimes physicians or dentists recommend antibiotics prior to a treatment, such as a teeth cleaning or root canal, to reduce the risk of infection.  This is because during some dental treatments, bacteria from the mouth can enter the bloodstream and cause infection elsewhere in the body. We only recommend this for certain patients, which is why it’s important to have a conversation with us and your physician.

2. Who Could Benefit from Antibiotic Prophylaxis?

Dr. Karagiorgos: With a few exceptions, most patients who require antibiotic prophylaxis before a dental visit will need it for one of two major reasons:

  • Risk of infection to replacement (artificial) joints–commonly the hip, knee, or shoulder.
  • Risk of infection in the heart.

The American Heart Association recommends antibiotics before dental procedures only for individuals with the highest risk of infection. This includes patients who have:

  • A prosthetic heart valve or who have had a heart valve repaired with prosthetic material.
  • A history of endocarditis (heart infection).
  • A heart transplant with abnormal heart valve function.
  • Certain congenital heart defects, including:
  • Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), which has not been fully repaired, including in children who have had surgical shunts and conduits.
  • A congenital heart defect that has been completely repaired with prosthetic material or a device (for the first six months after the repair procedures).
  • Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at, or adjacent to, a prosthetic patch or prosthetic device.

If you’re not sure what these guidelines mean for you and your particular heart condition, make sure to ask your cardiologist; “Do I need to take antibiotics for dental work?”

3. What if I’ve had Hip Surgery or a Joint Replacement?

Dr. Karagiorgos:  For many years, people that had undergone surgery for replacement of a joint (most commonly hip or knee joints) had to take antibiotics before any dental procedures. While this is generally still required for patients with two or more replacement joints, the American Dental Association no longer recommends routine antibiotics prior to dental procedures to prevent prosthetic joint infection.

Many orthopedic surgeons have their own criteria for deciding which of their patients might be at risk of joint infection with dental procedures (even cleanings). That is why in most cases I defer to a patient’s orthopedic surgeon to decide and prescribe prophylactic antibiotics for dental visits. 

If you have any questions about your particular situation, make sure to discuss them with me or Dr. Brunacini, as well as your orthopedic surgeon or physician.  This is especially important if you have a significant immunodeficiency or previously suffered an infected prosthetic joint. We are part of your health care team and will work together to determine if you have a need for antibiotic prophylaxis. 

4. What Else Should I Know?

Dr. Karagiorgos:  Good oral health and good general health go hand in hand.  So, keep up with your regular oral care routine of brushing twice a day, flossing at least once a day, and seeing your dental team with us for regular cleanings.  

At Falmouth Dental Arts you will notice that we ask you about any changes to your health history at every visit.  This includes medications that you are taking and any allergies you may have. It is important for us to know what medications that you take, and in what dosages and frequency. If you take many medications and it becomes difficult for you to remember them, then you can ask your physician to give you a current list that you can carry with you.  This information is important for us to know when determining the best course of treatment and care for you.

Also, I find it fascinating that the turnover of new tissue in the oral cavity is one of the fastest in the body!  Ever notice how a pizza burn in your mouth heals in a matter of days? The mouth is a great window into the body, often reflecting systemic disease before it can be determined by other means.  This is why we thoroughly examine all of the mouth, not just the teeth. We want to help you be healthy in your mouth and your whole body!

 

Thank you, Dr. Karagiorgos!

If you have questions about antibiotic prophylaxis or about how your health issues may impact your dental care, please give us a call today at 207.781.5900.  We are here to be your healthcare partner and provide you with the best oral care possible!

 

*Image courtesy of www.medlineplus.gov

An Interview with Dr. Brunacini on Oral Cancer Screening

Jun 20, 2019

Did you know that your routine dental check-up could save your life?  Dentists are on the front lines of a growing health concern: oral cancer.  Oral cancer is the uncontrollable growth of cells that invade the oral cavity (mouth) and the oropharynx (part of the throat at the back of the mouth).  According to the Oral Cancer Foundation, approximately 53,000 people will be newly diagnosed with oral cancer in 2019; that means 145 people each day.  Prevention and early detection is one of the most effective strategies for treating oral cancer, as when it is caught early there is an 80-90% survival rate.  Oral cancer screenings are an important part of our regular dental exams and something we want to help create more awareness about for our patients. To learn more about this critical health topic and the resources we have at FDA, we talked with Dr. Brunacini.

1.  Why is oral cancer screening an important part of care at FDA?

Dr. Brunacini:  As dentists, we are part of your health care team.  A lot of what is seen in the mouth can be an indicator of overall health and a lot of patients see their dentist more frequently than their physician.  That makes an oral cancer screening at the dentist extremely important for early detection of any changes in the mouth which can be the key to easier treatment options for oral cancer, as well as a rapid recovery, and a prolonged life.

2.  What happens during an oral cancer screening?

Dr. Brunacini:  A lot of the oral cancer screening is simply examining the soft tissues with our eyes.  We examine the gum tissue, lips, cheeks, and tongue. We also palpate areas of the face and neck to check for any nodules or lumps.  If there is an area of concern, we also offer to do a VELscope screening. VELscope is a non-invasive oral cancer screening device that emits a safe blue light that provides earlier detection of abnormal cell growth that could be cancerous or precancerous.  

3.  What are some risk factors for oral cancer?

Dr. Brunacini: The most common risk factors include tobacco, alcohol, and sun exposure.  Cigarettes and other forms of tobacco account for most cases of oral cancer and lip cancer is often caused by excessive sun exposure.

Also, another risk factor, although less known, is HPV (Human Papillomavirus).  It is a very common virus that most of us get exposed to throughout our childhood.  There is now a vaccine that can be given, which could help decrease the risk for oral cancer.  

Please let us know if you have any questions or concerns about these risk factors and your health.

4.  Are there any warning signs or symptoms for oral cancer?

Dr. Brunacini:  Yes, patients should be aware of any white patches or areas that bleed more easily, as these can sometimes be a sign of oral cancer.  If there is a noticeable and recent change in your mouth, such as tenderness or a change in the way your teeth fit together, it is always a good idea to let us know.  We will assess and address the issue and make sure that you are equipped with the information you need to make the best decisions for your well-being.

5.  If you find something during a screening, what are the next steps?

Dr. Brunacini:  Generally, if there is an area of concern, the next step will be a referral to an oral surgeon.  The oral surgeon will perform a biopsy of the area to determine the diagnosis. A lot of times, the biopsy determines that the area is not of concern.  However, when the biopsy is positive for cancerous cells, then further treatment may be indicated. Throughout this process, we are here to support our patients with the follow up care they need.

Thank you, Dr. Brunacini!  

We strive to be your dental care partner for a healthy life and always want to make sure you have information about how we can help you achieve that.  If you have any questions or concerns about your oral health or would like to schedule an appointment with an oral cancer screening, please call us at 207.781.5900.