FAQs, Useful Tips, and Links

Frequently Asked Questions

Why do some people have to take antibiotics before dental treatment?

People with artificial heart valves and some types of artificial joints may require antibiotics before dental work. Artificial heart valves are the highest risk; bacteria can get into the bloodstream (bacteremia) during the procedure, travel to the heart, and stick to the valves. The bacteria multiply into large colonies and destroy the valves, and/or seed throughout the rest of the body. For more information see, for example,

american-heart-org blurb

Not all dental work creates significant bacteremia, but for higher risk procedures, which includes dental cleanings, antibiotics are recommended, usually taken one hour prior to the dental appointment. Artificial joints can develop a similar problem, and an infection could require replacement of the joint. Until recently, even most heart murmurs (leaky valves) were also covered with antibiotics. The most recent guidelines are that heart murmurs do not require antibiotics unless the patient has had a history of bacterial endocarditic--that is, a heart infection. If you have previously taken antibiotics before all dental visits, you should ask us before your appointment to see if you are in one of the groups that should still take them. In 2009, the joint doctors changed their recommendations yet again, and now require that all patients with joint replacements take antibiotics before dental treatment, regardless of patient age or date of placement of the artificial joint.

Is there any way to avoid taking these antibiotics? I don’t like taking pills ...

Unfortunately, you can't just say "I'll accept the risk of heart damage, what do you want me to sign?" To go ahead with treatment under those circumstances would be malpractice for the dentist, and his or her insurance wouldn't cover it if something went amiss. Regarding artificial joints, it's a single dose, so look on the bright side--as recently as the 1990‘s, most orthopedic surgeons were prescribing a week of antibiotics for all dental treatment (yikes!) The rules get reviewed every several years, and if enough of you folks with artificial hips die from taking antibiotics, they might change the recommendations away from taking the drugs ☺.

Useful Tips

Toothbrush recommendations

While we don't specifically recommend any one type of electric brush, or sell them in our office, we do have some preferences. The Sonicare is probably the most popular, and although the sonic waves don’t magically kill all the bacteria, the vibrating motion does a good job of removing plaque. It’s especially good for those with arthritis, and the brush beeps every 30 seconds to pace you through the four quadrants of your mouth--very few people will brush the recommended two full minutes without this reminder. There are now several versions--make sure you get one of the newer ones with the improved brush heads. Older models the brushes are getting hard to find, so a bargain won’t be in the long run, as the brushes need to be replaced every 3 months or so. The fancier models have two speeds, an ultraviolet brush sterilizer, and other gimmicks which really aren’t worth the money in my opinion, but if Sonicare will give me a kickback, I’ll be happy to recommend the most expensive model. There are several sizes of heads available--get the smallest one, so you can get the brush back behind your molars. Sonicare now makes a kids version as well.

Oral B makes the Braun electric brush, which has some advantages over the Sonicare. For starters, they only make a small head, and the vibrations are slightly faster. The replacement brushes are generally a bit cheaper, which can add up over the years. Like the Sonicare, there is a beep every 30 seconds, and it comes in several varieties, including one with a wireless monitor so you can watch the seconds tick down. Clearly, some engineer had too much time on his hands when that was designed.

Both the Sonicare and the Braun have detachable heads, the idea being you can use one handle/motor for the whole family. We don’t advise this, there’s too much dribble-back, and it’s a little too much like sharing a toothbrush. Besides, the motors eventually wear out, and you will need to buy a new one twice as often if you’re using it twice as much. There are a couple of models that come with two brush handles and one charger, and that’s fine, there’s very little contamination potential with the induction charger.

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