Do you know someone who has a prosthetic knee, or hip? How about someone with a prosthetic heart valve? On the surface, these conditions probably seem to have little to do with dentistry. But the body has many parts, and all of them are connected.
The experts declare that any action that causes a person with a prosthetic joint or a prosthetic heart valve to bleed has the potential of destroying the prosthetic part. The proposed mechanism is that bacteria enters the body through the wound and can grow in accumulations (called bacterial plaques) on the implanted prosthetic joint or prosthetic heart valve. The experts tell us that a large dose of antibiotics significantly reduces the chance of bacterial plaques forming on this kind of prosthetic part after bacteria is introduced into the blood supply.
As with nearly anything in health care, there is controversy on all of this. The experts tell us that even though at times bacterial plaques form, when the plaques are analyzed they are made up entirely of bacteria not found in the mouth. This means that the bacteria forming the bacterial plaques had a source other than the mouth. As well, the treatment outcomes of those treated with antibiotics before dental treatment (many experts say) is no different than those not treated with antibiotics.
Regardless of the effectiveness of the currently prescribed antibiotics to control this condition, regulatory bodies across North America declare that dental treatment for people with prosthetic joints or prosthetic heart valves must be preceded with the antibiotic administration suggested by the American Heart Association. This means that if a dentist performs treatment normally causing blood to be seen and does not prescribe antibiotics as suggested by the AHA, it is considered professional misconduct. As with all standards of care, the patient cannot authorize treatment below the standard of care and somehow absolve the dentist of his duty to always perform treatment at least up to the standard of care.
Patients have asked me how seeing blood from a dental procedure and cutting yourself while slicing French fries is any different. The idea being I cut myself all the time and I never take an antibiotic first. The answer of course being if a person with a prosthetic heart valve or a prosthetic joint knew he was going to cut himself or stub his toe, an antibiotic premed would be needed for that too.
Over the years, scientific thought on this subject has changed. Number of doses and time after surgery that medication is needed has been reduced. Rest assured, the dentist would love it if this requirement disappeared. At any rate, if and when another change comes in this standard of care your dental team will let you know. Be sure to ask your dentist if you would like more information on premedication for patients with prosthetic joints and prosthetic heart valves.
This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)