For most people, minor dental procedures are not much to worry about. We routinely get cavities filled or even a deep teeth cleaning without a second thought. However, some patients don’t have the luxury of this casual approach to necessary dental services. For them, dental prophy is a potential lifesaver.
What is dental prophylaxis?
Dental prophy, also referred to dental prophylaxis, is utilized when a dentist determines that a patent is pre-disposed to bacterial infection. The dentist will then prescribe antibiotics for use prior to the dental procedure.
For vulnerable patients, antibiotic prophylaxis may be necessary for even minor dental procedures (e.g., filling cavities).
What’s the difference between prophy vs. perio maintenance?
There is often confusion surrounding prophy and perio maintenance as procedures for preventing the spread of bacteria and halting periodontal disease.
Prophy
Prophy in this case deals with the cleaning of a healthy mouth. The American Dental Association (ADA) defines a prophy as:
“Dental Prophylaxis – D1110 – Removal of plaque, calculus and stains from the tooth structure in the permanent and transitional dentition. It is intended to control local irritational factors.”
Stains and minor blemishes in the teeth are generally located above the gumline. Your dentist can easily polish or brush them away during a regular dental visit.
This type of cleaning is useful when there is no sign of periodontal disease, including:
- Bone loss
- Bleeding
- Gum recession
- Structural instability (i.e., loose adult teeth)
Prophy in this case does not have much to do with dental or antibiotic prophylaxis. A healthy adult with a healthy mouth can stay that way with just two of these types of cleanings annually – no antibiotics required.
Perio maintenance
Periodontitis (a.k.a. periodontal disease) is a chronic bacterial infection caused by dental biofilm that is filled with bacteria. This biofilm causes bone destruction and tissue deterioration to such an extent that tooth loss is often the result.
Periodontal disease and its bacteria quickly overwhelms the body’s immune response. This leads to a breakdown of tooth structures. This disease can be episodic, triggered by stress, systemic disease, or other dental issues.
The ADA differentiates perio maintenance from prophy in the frequency of it, the location of the dental debris, and the reoccurrence of bacteria, noting:
“This procedure is instituted following periodontal therapy and continues at varying intervals. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planning where indicated, and polishing of teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.”
In effect, perio maintenance is a type of cleaning that differs from dental prophy in its scope and depth. The complexity and scope of the infection necessitates regular scaling and root planing as well as the potential for treatment with antibiotics.
Dentists generally recommend regular dental cleanings (prophy) to alternate with perio maintenance for those with periodontal disease. This means that instead of two cleanings a year, patients with periodontal disease will receive up to four.
In a discussion about antibiotic prophylaxis, perio maintenance may come up. Patients with periodontal disease have a tendency to bacterial infection. It is possible that they may require dental prophylaxis prior to perio maintenance.
Who needs dental prophylaxis?
Contrary to what was believed in the past, there are actually only a small percentage of patients for whom antibiotic prophylaxis is necessary.
The American Dental Association has recently revised its guidelines to reflect research developments in the understanding of the actual threat of bacterial infection during dental procedures. They examined the following populations.
Patients with prosthetic joint implants (no complications)
Previously, dentists believed that the threat of bacterial infection was greater in patients with prosthetic joint implants.
A 2014 review of research found that dental prophy was not recommended for this population, citing an absence of existing infection in the prosthetic joint.
Patients with prosthetic joint implants (complications)
For patients who have experienced complications with their prosthetic joints (e.g., infection), the decision to utilize dental prophylaxis should be made in conjunction with the orthopedic surgeon.
If the orthopedic surgeon deems antibiotics to be necessary, they should be the one to decide the type and course.
Patients with cardiovascular conditions
The population that seems to be of most concern when considering dental prophy is those with cardiovascular conditions. Bacteria that gets in the bloodstream after invasive dental procedures (e.g., crowns, root canals, treatment of dental abscess) can cause infective endocarditis.
Six types of bacteria can cause this life-threatening infection:
- Viridans group streptococci
- Staphylococcus aureus
- Enterococcus
- Pseudomonas
- Serratia
- Candida
The irony of this is that vulnerable patients are routinely exposed to these bacteria on a daily basis when they brush and floss their teeth. It may be a judgment call for the oral surgeon as to whether the risk of developing antibiotic-resistant infection is worth administering dental prophylaxis in these cases.
Highest-risk patients
The American Dental Association does recommend without reservation the use of dental prophy for the following patients:
- Patients with a history of infective endocarditis (regardless of cause)
- Patients with prosthetic cardiac valves or prosthetic material used for cardiac valve repair
- Cardiac transplant patients with valve regurgitation due to an abnormal valve
- Those with congenital (present from birth) heart disease that is either unrepaired or repaired with valve regurgitation or residual shunts near a prosthetic device
In addition, patients who have a compromised immune system or a history of vulnerability to infection may want to consider the possibility of dental prophy when receiving invasive dental work.
Even though there is a fairly narrow subset of people who benefit from dental prophy, the choice is one that requires thought and consideration. Overprescription of antibiotics has contributed to the evolution of drug-resistant bacteria. It’s important to limit your exposure to antibiotics as much as possible, but to use them when it’s vitally necessary.
If you are concerned about your risk when it comes to bacterial infection during a dental procedure, call AZ Dentist, your Phoenix area dental clinic. We can help you better understand your risks and treatment options.