Antibiotics after Joint Replacement… yes or no??

When a family member recently had a full knee replacement she was surprised when Dr. Boyd asked her if the doctor had mentioned that she would need to have antibiotics when having dental work for the next two years at least. Apparently the orthopedic surgeon had not mentioned that. Thinking about it later it seemed like a good time to talk to our patients about this. Afterall, over a million (!) joint replacement surgeries are done every year.

To provide the most current information on the need for pretreatment antibiotics before dental treatment we checked with the American Academy on Orthopedic Surgeons (AAOS) and the American Dental Association (ADA). What we found when we check with these sources was that there was currently no consensus in their recommendations! How could that be? So we dug a little further and learned a little more about the lack of consensus.

In 2003, the ADA and the AAOS issued a report stating that antibiotics should be administered one hour prior to dental procedures for patients with “high risk” conditions and patients with prostheses less than two years old. Pretreatment antibiotics were not recommended for otherwise healthy patients with joint replacements. This recommendation stated that “the risk/benefit and cost/effectiveness ratios fail to justify the administration of routine antibiotic prophylaxis.” For five years this was the consensus in the thinking when it came to prescribing prophylactic antibiotics to patients who had undergone joint replacement surgery. Then in 2008, without input from any other organizations and without any studies to back it up, these recommendations were discarded by the AAOS.

In 2009, the AAOS issued an information statement that said, “Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia.” In other words, if you have had joint replacement surgery you should be treated with antibiotics before having dental work for the rest of your life.

The American Dental Association, the Canadian Dental Association and the American Academy of Oral Medicine have taken issue with this recommendation. They state there was no clear explanation or scientific basis for this change in position. In fact, studies have shown that joint infections rarely are caused by bacterial species common to the mouth. Bushing teeth and other routine dental procedures cause the same bacteremia as invasive procedures, though on a lesser scale, and no one is suggesting daily antibiotic prophylaxis. That would be ridiculous!

So what do you do if you have had joint replacement therapy? Well, if it has been less than two years since the surgery or you are a high risk patient the ADA and the AAOS both agree that you should take antibiotics one hour prior to dental treatment. If you do not have high risk conditions and it has been longer than 2 years you should talk to your orthopedic surgeon to find out what they recommend for you. If the orthopedic surgeon wants you to continue to take antibiotics before dental treatment it is a good idea to get the surgeon to write out the orders so that it can be put in your dental record.

We understand that the AAOS is continuing to look at the relationship between joint prostheses, infections, and dental treatment. We hope that in the near future there is a guideline that is acceptable to both the AAOS and the ADA. Even though both organizations may not be in full agreement regarding pretreatment with antibiotics before dental treatment it is important to your health to be sure to let your dentist know if you have had joint replacement surgery – especially if it has been within two years.

references: www.aaos.org; www.ada.org; www.dentistry.com; jada.ada.org; www.cda-adc.ca/jcda;

www.drboyd.com

We Have An App For That…

We are always trying to find ways to make it easy for our patients to keep in touch with us.  We have our website (www.drboyd.com), we are on Facebook (facebook.com/bradfordboyddds), we are on Twitter at (twitter.com/bradfordboyddds), and we are on Google+ (Bradford Boyd, DDS, Inc.).  We even are on Youtube (bradfordboyddds) where you can see a video of Dr. Boyd doing an oral cancer screening on Ben.  Now, in addition to all of this we have our own app! 

We first saw this app on the local channel 5 morning show this past summer and as soon as we saw this we knew we had to have this for our patients. 

So, you might wonder how you can go about getting our app.  Well, it’s easy, just go to the Apple App Store or the Android Market and download the app called “My Dentist”.  Once you have downloaded that you enter the Provider Key as drboyd.  Then fill in your name, email and phone number and you are ready to use the app.  Pretty easy! 

Once you have the app on your phone you can see that you can contact our office, request appointments, get a map to the office, go to our website, etc.  This app was designed to make communication with our office convenient and hassle free.   

We hope you take the time to download it and let us know what you think of this app. 

www.drboyd.com

Tricky Treats

Ahh, it is that time of the year again, Halloween. Time to pass out treats to the costumed kids.

For a number of years we lived on a street in town where most everyone on the street put out decorations and where thousands of people came to our door every Halloween night. And I do mean thousands. One year we even used a counter and stopped counting when we got to 1200. For most of those years we passed out disposable toothbrushes along with their candy treat. Yep, we were that house. As the years passed we would hear parents tell their children to go up to the house and get their toothbrush. I don’t know how excited the kids were, but the parents seemed to like the idea. We got the feeling from some of the kids that this was the first new toothbrush they had all year – and it was a disposable one. I imagine the first Halloween after we moved people wondered what happened to the toothbrushes.

I remember the fun I had as a kid going to neighbor houses and getting a candy treat. I never wanted to be the house that didn’t give out candy so adding the tooth brush was my way of trying to set a good example. Halloween can be fun for kids, but the dental problems that can arise from eating all of those sugary treats is not so fun.

Having a piece of candy or two is not going to lead to massive tooth decay. However, if children are allowed to eat their way through huge bags of candy there can be problems down the road. They can still have candy, but they shouldn’t have it one piece of candy after another all day long. The constant snacking provides a continuous supply of sugar and that feeds the bacteria that causes decay. It is best if kids indulge only during mealtimes to limit their exposure to sugars.

The most important factor to keep in mind are the types of candy and how the treats are being consumed. Acidic and sweet candies are some of the worst offenders. If the acid in the candies is allowed to stay on the teeth the enamel can erode, leading to decay. Sticky treats such as taffy and gummy candies get stuck on teeth and expose the teeth to sugars and bacteria. On the other hand, chocolate melts in the mouth and does not generally coat the teeth. I like to tell kids that the bacteria eat the sugar and then “pee” on their teeth. This is an image that they seem to remember.

A good thing to do when your kids head out for trick-or-treating is to make sure they have a bottle of water with them. They should be told to swish the water around their teeth after they sample any of their Halloween goodies. This dilutes the sugar and acid. As soon as they get home they should brush their teeth and make sure that as they work their way through their Halloween treats they are vigilant with the care of their teeth.

Children with braces have even more to be concerned about. Hard candy can cause brackets to pop off, leading to longer treatment times. Hard candies and chewy, sticky candies are hard on teeth with braces. I noticed that one of the orthodontists in town is buying back the

One last word about trick-or-treating: be aware, be smart, have fun!

www.drboyd.com

Beware of Hard Candies Redux

September 2009 we wrote a blog on how hard candies can wreak havoc with your teeth. Since then we have seen many more adult patients who have developed an alarming number of cavities from sucking on hard candies all day and so we thought we should update the hard candy blog.

Many people find themselves with dry mouth, often due to medications such as antihistamines, medication for high blood pressure, anti-depressants, etc. Unfortunately, many people try to alleviate this problem with hard candy or cough drops, which can have a very high sugar content. Since these candies sit in your mouth for a prolonged period of time the bacteria that naturally live in your mouth feed on the sugar, turning it into acid. This acid then eats away at the hard enamel on our teeth causing decay in a short period of time. The longer this acid bath lasts the greater the chances for tooth decay.

If you find yourself suffering from dry mouth a special toothpaste or rinse can be prescribe to alleviate dryness. Fluoride is also good to slow decay.

If you eat hard, sticky, or gummy candy – anything that sticks to teeth or stays in the mouth for a long period of time – you are asking for big trouble. Make sure you use a sugar-free candy and avoid prolonged periods of time with anything that contains sugar (i.e. sipping sports drinks, power drinks, sodas, chewing gum, candies or mints – even antacids). A const5ant diet of sugar feeds the bacteria all day long and they continually excrete acid onto your teeth. After any sugar ingestion rinse well to dilute the sugars and the acids and brush your teeth as soon as you can with a fluoride toothpaste. Be sure to brush at least twice a day, paying special attention to the gum line.

If you must eat sugar – eat it and be done with it. Then rinse your mouth with water.

http://www.drboyd.com

The Cost of Dental Treatment…

People often ask us if it is important for them to get the treatment recommended for a tooth that has a cavity. Sometimes people think they are just little cavities and it's okay to put off treating them until it is more convenient. Sometimes it's because a filling can cost around $200 and they'd rather spend the $200 on something else.

When a patient asks whether or not they need to have work done we tell them about the exponential cost of dental treatment.

You can have the cavity treated while it is small and relatively inexpensive, or you can wait until it is more convenient. But you need to know that the cavity might just keep growing and may grow into the nerve. You’ll know when that happens because you will have a nasty toothache that will cause you to find your way back to the dental office for an emergency appointment. And you just know it is going to happen on a weekend, so you will have to wait until Monday to get treatment. The sad news will then be that a filling is no longer recommended because now you need root canal therapy and a crown - and the cost is over $2000. This time you can’t put off treatment because you are in pain.

Maybe you decide to have it pulled because it is cheaper now and you figure you will just get an implant later. We can do that, but just know that the implant itself will entail trips to the oral surgeon, a 4 – 6 month process for the implant to integrate with the bone, will cost over $2000, and then you still need a crown at a cost of over $1000.

Or maybe you don’t want an implant and just figure you will get a bridge to replace the tooth. A 3 unit bridge costs the same as three crowns – over $3000.

Of course you can always just have the tooth pulled and look like Alfred E. Newman – What, me worry?

The choice is yours.

http://www.drboyd.com/

You Made Us Smile!

In the last week we have received some wonderful reviews of our office.  One, in particular,  I wanted to share because it just made my day when I read it this morning.  Here it is…

“Great Experience!  The staff is friendly and professional.  I was provided with all of my options (including a print out of the costs involved) but never felt as if I was being sold anything.  Dr. Boyd explained, without having to be prompted, the reasoning behind his conclusions about what should be completed.  For the first time I felt as if a dentist was treating me like a person instead of a pocketbook.  Mel made sure that I was comfortable, Leslie was friendly and gentle, and Ben helped me prepare for my next visit.  My visit interrupted my workday and the staff made sure that I was back to the office on time without skimping on service.  Also the website is really useful!  I really can’t say anything unpleasant; I am so glad that I found this dentist office.”

I couldn’t ask for a nicer review!  We love our patients and feel so great when we know we are providing the kind of service that we work hard to provide! 

I’m still smiling… :)

 

http://www.drboyd.com

Tell Me Again, What's a QR Code??

Have you been noticing those odd squares that look like some kind of bar code? Did you know that they are called QR (Quick Response) codes? I've been seeing them in magazines recently and have been curious about them. The other day I was watching CNN and they had a QR code that they displayed on the screen. They were encouraging everyone to scan it and it would take ypu to to a place to donate to victims of that horrible earthquake/tsunami/nuclear meltdown disaster in Japan.

So what do you find when you scan one of these codes? Well, it turns out that you can get a whole range of information from these little squares, depending on what the developer of the codes wants to use it for. You can get an email, a text, a picture, a video, a website, general information, contact information, etc., etc.

I’ve read that the codes were originally developed in Japan to track parts for vehicle manufacturing at Toyota, but now they are being used for a wide variety of information. How do you access this information? Using your cell phone’s camera you scan the information and after it processes the information it pops up on your screen. Some phones are already set up to scan while others need an app to do the scanning. Once you have the app it is really easy. Just take a picture of the QR code, let it quickly process the information and voila – there it is on your phone!

We recently went to a class by socialmediadentist.com and discovered that we could be using these codes in our dental office. Since attending that class we’ve been developing a number of QR codes to make it easier for people to access our information online. Patients can now scan separate codes to take them to our website, to follow us on Twitter, to take them to Facebook where they can “like” us, to take them to this blog, to read patient reviews of the office, to check in using either Facebook, Foursquare, or Google Lattitude, etc. We plan to offer post procedure instructions through QR codes as well. Who knows what else we will make a QR code for.

So discover what QR codes are all about. Get the app if you need one and don’t already have one downloaded on your phone - ScanLife is an app we have been using. Now scan the QR code above and see what you find…

http://www.drboyd.com/