An Interview with Dr. Karagiorgos on Antibiotic Prophylaxis
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