Have you had a joint replaced –A Hip? Knee? Does this mean that you need to have prophylactic antibiotics before undergoing dental treatment? Probably - but the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) are now working together to develop new evidence-based guidelines for antibiotic prophylaxis for dental patients who have total joint replacements. The new guidelines are expected to be available by 2011.

The previous guidelines issued in 2009 were inconclusive: “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.” Invasive dental procedures can cause bacterial invasion, so antibiotics need to be “considered” – and most cautious clinicians will recommend the antibiotics.

Prior to 2009 routine antibiotics were recommended only within the first two years following joint replacement and after that only for patients at increased risk. Confusing? You bet ya! For more information visit http://www.aaos.org/research.

I’ve seen it too many times: a healthy, young adult with ten to twelve blackened teeth, crumbled and decayed down to the gumline.  It is a horrific, tragic sight. The cause?  Too often it is Methamphetamine use. The first anecdotal accounts of “methmouth,” as it has come to be called, started to appear in the dental literature several years ago. It struck a cord of recognition – yes, I had also seen this debilitating decay in several patients at my East Setauket dental office.

Methamphetamine is a powerful psychostimulant that has become prevalent because it is easy to manufacture and relatively less expensive than other illicit substances. Over 12 million Americans have tried methamphetamine at least once and most users are between 18 and 34 years.

A recent study in the Journal of the American Dental Association examined the relationship between meth use and dental decay (http://jada.ada.org/cgi/content/full/141/3/307). The study confirmed what dentists have seen anecdotally, and the authors conclude that “overt dental disease is one of the key distinguishing comorbidities in meth users who otherwise generally are healthy.” They also found that, contrary to common belief, people who smoke or inhale meth have less dental disease than those who inject meth. More research needs to be done to determine the scientific basis for the connection of meth and dental disease.

The meth users that I have seen in my dental office were concerned about their dental appearance, a fact also borne out by the JADA study. Dentists can thus play an important role in the early detection of meth use. Dentists can also play a role in the recovery process by restoring patients’ dentition and helping them regain a positive self-image.

Today the Port Jefferson Chamber of Commerce held its first Health & Wellness Expo at the Village Center. Over 50 exhibitors were on hand to answer questions, distribute information, provide screenings and education seminars. I also participated and answered questions about teeth whitening, missing teeth, implants, crowns and porcelain veneers. It was wonderful to meet so many new people and see some old friends. I also had the opportunity to hear Dr. Raja Jaber speak on “Lifestyle Medicine,” an approach for patients to develop wellness skills such as the adoption of wholesome nutrition, better sleep habits, appropriate exercise, stress reduction and elimination of harmful addictions. The purpose of the Expo was to “promote good health” – and I hope good oral health too! For more on dentistry and lifestyle, see my webpage on Wellness.