Archive for the ‘prevention’ Category

Be Dentally Prepared for Joint and Heart Surgery

Wednesday, July 8th, 2009

When certain kinds of surgeries are done, those areas can be especially compromised by the presence of bacteria. Of course, your doctor is going to make every effort to provide a sterile operating environment, but the bloodstream could be a potential source of hidden bacteria.

In most cases, this is not a critical factor, however in some areas such as around artificial joints or heart valves, the circulation is a little restricted, leaving them more susceptible to bacterial attack than other tissues in the body. Some common measures taken to avoid any occult bacteria in the blood include premedication with an antibiotic just before surgery, and preventing any other source of infection that may arise. Watch out for cuts and scrapes of course, but the most obvious place to find lots if serious bacteria is in the mouth.

Even though decay is produced by bacteria, it doesn’t get into the blood until it infects the nerve. That’s certainly a potential for bacteremia. I found one of those in a patient scheduled for surgery the next week and the doctor had to reschedule it until we were able to resolve the infection.

However, it is much more likely to find problems in the gums. Depending on the study, the prevalence of gingivitis or periodontitis ranges from 65% to 75% in America. If you haven’t been keeping up with your dental cleanings, you might be one of those statistics. In view of the health issues associated with periodontitis, it is always a good idea to prevent that bacterial plaque from working its way under your gums, but if you’re planning on surgery, it’s especially important to get your mouth in order.

I’ve heard of an eleventh-hour approach by surgeons who tell their patients a week before the surgery to not brush their teeth very hard so they don’t stir up any bacteria that could be present in their gums. While this might be good advice at such a late hour, a much better approach would be to try to eliminate any oral infections well in advance of the surgery. If it is an emergency, you have no choice of course, but most surgeries are at least planned if not scheduled months ahead of time. Plenty of time to resolve any urgent dental problems, and just because nothing hurts, don’t be lulled into thinking everything is okay. Most dental infections are not painful.

Here is a strategy I recommend. As soon as you decide on a surgery, inform your doctor that you are planning to get a complete dental check-up, if you have not done so recently. Have full mouth x-rays taken and a periodontal examination. At this time it is not necessary to concern yourself with any elective procedures or minor problems. You’re just looking for potential sources of infection. Get those taken care of along with adequate gum therapy which could be just a simple cleaning or more. Then brush and floss thoroughly every day right up to the day of your surgery. That will prevent a buildup of bacterial plaque.

If the surgery is just a week or two away, skip the gum therapy but have the teeth x-rayed. I’m sure your doctor would like to know if you have an active abscess going on. Dentures can also create hidden infection occasionally, so it is good to get those checked. Needless to say, the best approach is to stay current on your exams and cleanings, floss every day, and don’t smoke!

Dr. Moulton’s article was published in the Desert Valley Times, February 2007

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