Prevention of Joint Infections (Dental included!)

[Debcoco]

Hello,

I was researching information regarding joint infections.  I was mostly concerned about dental infections.  (after reading the info in the link below...now all infections!) My Dr prescribed antibiotics for me to take 1 hr prior to ANY dental treatment for the next 2 years.

I found this link to be very informative:

http://www.hss.edu/conditions_prevention-of-infection-joint-replacement.asp

[keepmovin]

This was a great article!  Very thorough!  I have been advised to take antibiotics before dental visits for the rest of my life, not only because of my shiny new hips but also have a very mild indicator of mitral value prolapse.  It's a simple, safe way to play it safe.  I've been to a few different dentists through the years and no matter the dentist, they insist on the antibiotics. 
 

[hernanu]

There is some evidence that it may not be needed, but I am also prescribed these for life before dental procedures, and I'm fine with that.

Tomorrow I'm going to get a crown replaced (caused by biting into a throat lozenge, so a cold led me to dental issues), so I'll be doing four pills one hour before the procedure.

[luann again]

You are correct, Hernanu, the American Heart Ass. (Who sets the recommendations) recently stated that their is no evidence that prophylactic antibiotics have any effect in the prevention of joint replacent infections. (this topic was all the rage at the dental convention I attended in Oregon last year)The Ass. did, however, stop short of actually saying they are not needed. Dentists face liability issues if they do not have have patients take them ( Even if deep down inside, they too, think they are overkill). But they WILL let you go without if your ortho. Dr says you do not need them. Always go by your Dr's orders, of course, but many are revising their originally orders so it does not hurt to call and ask if you still need them.
Many may think, "Well, it's just a few pills, what's the harm?" As we all have heard by now, any unnecessary antibiotic use should be curtailed as we are breeding "super resistant bugs". There are also stomach/intestinal flora damaging issues, and allergies. Again, do as your joint surgeon recommends, but if you have had your replacement for awhile, it might not hurt to call and check to see if they are still needed. I am hoping in the future the AHA research is correct and none of us will have to take them anymore.
By the way, Hernanu, if it makes you feel any better, that tooth break was going to happen sooner of later. It is not really what you are eating that makes it break (unless someone is consistently chewing on rocks!! but the action of chewing. I have patients come in to see me that say they were eating bread or lettuce when the disaster occurred. It was weak and ready...the circumstances just helped it along. Moral- it was nothing you did, you're off the hook!
Lu (dental hygienist) 

[Debcoco]

Lu,

Thank-you for the good info. I wondered about the effects of too many antibiotics.  My Dr said to  use the antibiotics for 2 yrs and then I could stop. I figure since I go twice a year this will be 4 times I'll have to follow this prescription.

What is your opinion on mouthwash? Are there any that will "kill bacteria" ? I've been wondering if I should get into the habit of using mouthwash once a day.

debcoco

[Jason0411]

Still can't understand why in the UK this does not seem a concern? Nobody ever mentioned it to me.

[luann again]

Hi Debcoco,
I work in a general practice and a periodontal practice (gum disease specialists). Most, if not all, OTC rinses are very ineffective. Listerine may have some germ killing properties, but they are very superficial and not very long lasting. It also contains quite a high percentage of alcohol which can increase a person's chances of oral cancer and is very drying to oral tissues.
The very best preventative of joint infections due to oral microbe invasion is very good home care of teeth and plaque control!! Concentrate your brushing efforts at the gum line (right where tooth and gum meet) this is where plaque forms. Good interdental (between the teeth) plaque control is important, too. Yes, (that four lettered word with five letters!) flossing. Tooth picks can be good for between teeth, too, but nothing can get under the gum like like floss. It is also important to have a professional cleaning of teeth at least twice a year (more often for gum disease patients) to get the tarter and plaque off that you cannot remove.
Plaque that is not removed sits on your tooth's gum line. Without you even know it (although sometimes there is visible bleeding) it causes microscopic gum bleeding (from the bateria's gum destroying waste products ) that allows the bacteria to enter the bloodstream. This is how it can (in theroy) get into vulnerable joints (ie- our implants). So even though mouthwashes can help by killing this bacteria, REMOVING it first, is our best protection!!
If you have serious dental concerns, (dexterity problems that prevent you from effectively removing plaque uncontrolled gum disease,etc.) then a mouthwash can help you. The standard one is by Rx only and is called Chlorhexidine gluconate (brand names:Peridex or Perioguard) You could ask your dentist if it would benefit you.
But... (Now I know I am going to get some gasps from this!!) the newest rage in US dentistry is a fabulously effective rinse that is safe (YES SAFE!!) to use for anybody (I have not heard of any contraindications, even pregnancy).  All the practices I work in recommend it for all patients. It is inexpensive, easy to use, non-Rx, and we have seen amazing results ( less gum bleeding, less plaque, reduced gum disease, less cavities). It is a BLEACH and WATER mixture (look up Dr Slotts, who did all the research and developement).

ONLY NEED TO USE 2x A WEEK (ie- perhaps choose Sun and Weds) The germ killing effects are sustained for days after use!
Recipe: 1 teaspoon bleach (6%)
             30 teaspoons water
              3-4 teaspoons mint mouth wash (just so it tastes better)
              ( helpful hint- measure water and "mark the cup" then add mint and bleach)

             After MIXING FRESH EVERY TIME YOU USE (mixing too early will make it lose it's effectiveness)
              Take a mouthful (don't need to use entire mix) and swish for 30 seconds to 1 min
               Then spit out
Again, it is safe, you only have to use 2x's a week, it is cheap, and no- it will not also whiten your teeth
We have had patients on it for about 2 years and have seen great results. Many report that it gets easier to use each time ( at first it tastes like "salty pool water")

Well, there it is. I would be happy to answer any more questions!
Lu (RDH registered dental hygienist)
               
               Be careful not to spit, drip on towels by sink or your clothing, as it may whiten/spot     
               fabric

[hernanu]

By the way, Hernanu, if it makes you feel any better, that tooth break was going to happen sooner of later. It is not really what you are eating that makes it break (unless someone is consistently chewing on rocks!! but the action of chewing. I have patients come in to see me that say they were eating bread or lettuce when the disaster occurred. It was weak and ready...the circumstances just helped it along. Moral- it was nothing you did, you're off the hook!
Lu (dental hygienist)

So I had my session, got a temporary crown, permanent one coming in three weeks. I did my usual four antibiotic pills. I was also told that it was ready to happen, so all of the guilt and remorse were for nothing  :-)

I didn't remember, but I apparently had it done twelve years ago, so it had a good run, I guess 5 years on is the norm. I'm hoping this is a trend, and I have an outlandishly long run on other artificial add ons to my body, with my HR's going into infinity.

I do floss religiously (no, not just in church), having been scared spitless by my hygienist when she saw my gums deteriorating a bit. She showed me the impact of not doing so, so I have picks and floss at home, work and in the car.

I am a full service flosser, and it completely reversed the decline and fall of the hernanu gums.

[Debcoco]

Lu,

WOW!!  Thank-you so very much for all of this detailed information and the recipe for the mouthwash...I will definitely be using this!

Joint replacement is a new world to me (as it is for probably all on this site) and I'm trying to learn all I can about staying healthy and safe.

deb

[luann again]

So glad to help Debcoco and Hernanu!

Hernanu- goody for your hygienist to scare you spitless! ( you are so funny!!) She has done you a huge favor. Gum disease is the #1 way that adults lose teeth. If you only brush, you are only removing plaque/bacteria from 3 out of 5 surfaces of each tooth. If she has truly converted you, she has saved you $, discomfort, possible systemic health problems, and time spent in the dental chair! Flossing will also help prevent decay around your new crown (very common!).

Debcoco, you are very welcome! I am passionate about oral health. Please also floss along with Hernanu.

Lu