Do Bugs Always Need Drugs?

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It’s flu season and the line up in the pharmacy for antibiotics is getting long.  We all would like a quick recovery and end the misery of lethargy, runny nose and cough by popping a pill.   Antibiotic use is; therefore, becoming more common, even in viruses induced illnesses such as a cold or the flu.  But is antibiotics the correct way to go when it kills bacteria not viruses?   Using antibiotics too often, which does not even help viral infection anyways, can lead to antibiotic resistance.  Bacteria resistance to antibiotics can happen naturally and on it’s own, although frequent use of antibiotics can increase its chance.  Bacteria gets accustomed to the exposure of antibiotics in its surroundings and it can mutate or learn to build an immunity against it.  Doctors are running out of options worldwide in finding treatment for serious diseases, like pneumonia or skin and gastrointestinal infection caused by superbugs such as methicillin-resistant Staphylococcus aureus (MRSA) and  Vancomycin resistance Enterococci (VRE).  Sometimes these superbugs are not only resistant to one but multiple kind of antibiotics.

Fortunately, there is something you can do to prevent bacteria resistance to antibiotics.   Antibiotics should only be used when they are prescribed to you by your doctor; when he or she can confirm with testing or has reasonable suspicion that your illness will be beneficial to the use of antibiotics.  Finishing the entire amount of the prescription is vital and never share antibiotics with anyone.   Washing and sanitizing hands sounds awfully simple but it is very effective in preventing the spread of bacteria.  Cough and sneeze into your sleeves or tissues and not your hands.  Avoiding touching moist areas of your face such as the mouth, eyes, and nose because it is an easy entry for microorganisms into your body.    

Please don’t be disappointed when your dentist did not give you a prescription of antibiotics.  From a dental perspective, clean wound related to trauma on a healthy individual may not need to be treated by antibiotics.   If a child has acute pain because of cavity infecting the nerve of the tooth, providing immediate treatment for the offending tooth (ie, pulpotomy, pulpectomy, or extraction) would be better than taking antibiotics.   Antibiotic therapy usually is not needed if the dental infection is contained within the immediate surrounding tissue and the child does not show signs of a spreading infection.  Antibiotic use should be reserved for a child who is suffering from high fever, facial swelling or a child who is immunocompromised.  

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What does your heart have to do with your teeth? Is your child at risk for infective endocarditis?

When you come for a dental visit,  Dr. Tsang may ask many questions about your child’s medical history.  Sometimes you wonder why she needs to know so many details?

It is important for her to understand the complete picture of your child’s current health status in order to provide the best care for your child.  With a thorough understanding of one’s medical health, she will know what health interventions would be best suited for your child and will not precipitate any medical concerns your child may already have.   One of the medical conditions that may really catch her attention is heart murmur.

What is a heart murmur?

When your heart beats, valves in your heart makes a “Lub-Dub” sound.  A heart murmur is an extra or unusual whooshing sound that can be heard in addition to your normal heartbeat.  Murmurs can be very faint to very loud.  There are two types of heart murmurs; innocent heart murmurs (not threatening) and abnormal heart murmurs.  An innocent heart murmur is not caused by a heart problem.  It is usually caused by strong blood flow through your heart and can often occur in healthy children.  Children who have an innocent heart murmur do not have to limit their physical activities and do not need any treatment.  In contrast, children with abnormal heart murmurs may have congenital heart defects that are present at birth and are often accompanied by other signs or symptoms of heart problems.

Often, your doctor can tell right away whether a heart murmur is innocent or not by just listening with a stethoscope.  On occasion, your doctor may request further testing, like an echocardiogram, to clarify whether it is innocent or abnormal.   It is pertinent to distinguish what type of heart murmur your child has because there are some medications and procedures that are not suitable for someone who has a heart condition.   Extra precautions (like taking an antibiotic) may be necessary before any dental procedures are safely carried out for these children.

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What is infective endocarditis?  How serious can it be? What is the potential link to dentistry?

It is an infection of the heart valves or lining of the heart when bacteria or other organisms enter the bloodstream.  Once in the bloodstream, bacteria build up on a valve or the lining of the heart where damage may have occurred.  The symptoms are fever, chills, fatigue, weakness, aching joints and muscles, shortness of breath, cough, swelling in the feet or legs, blood in the urine or the onset of a new heart murmur.  Infective endocarditis is a rare complication that can occur after having dental work completed as bacteria in the mouth enter the blood stream during a dental procedure .  If your child was born with a congenital heart disease, have artificial heart valves, or previous history of infective endocarditis, you should inform our dentists before any treatment as he or she may have higher risk for infective endocarditis after dental or medical procedures.  One intervention that can be used to prevent this type of complication is the use of antibiotics before having any treatment completed.  We follow the American Heart Associations guidelines for antibiotic treatment prior to dental procedures to prevent infective endocarditis.  These guidelines support those individuals who are at highest risk of developing infective endocarditis receiving short-term preventive antibiotics before common dental or medical procedures.  We also take the time to consult with your child’s physician before starting any treatment if there is need for clarification.  Here are some easy tips for you to help us if your child has a cardiovascular history:

  • Ask your doctor for any special preparations

  • Inform our dentists and discuss with them your child’s condition prior to treatment

  • Know what medications your child is taking, if any.  For example, some heart medications may cause excessive bleeding during dental procedures

  • Be prepared to give our dentist your doctor’s name and address

  • Be prepared to give our dentist permission to contact and consult with your doctor

Copyright 2014 The Children’s Oral Care Centre