Addition to patient history

JADA L E T T E R S

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JADA devotes this section to com ment by readers on topics of cu rre n t interest to dentistry. T he editor reserves the right to edit all communications to fit available space an d requires that all letters be typed, double-spaced, and signed. No m ore than ten references should be given with each letter. Printed communications do not necessarily reflect the opinion or official policy of the Association. Your participation in this section is invited.

the ancients th a t the ea rth was flat. T h e re is too m uch in fo rm atio n available □ T h e in tro d u c to ry rem a rk s to the Em ­ to s u p p o rt o r re fu te m any o f th e observa­ phasis article, “R estorative den tistry and tions stated in this article, an d m ore r e ­ total oral health: advances in tissue m an ­ ferences should have been given. As B en­ a g e m e n t” (O ctober), clearly stated th a t ja m in Disraeli said, “As a g en eral ru le, th e th e re a re ways in w hich th e gen eral d entist m ost successful m an in life is th e m an who an d the specialist can co o rd in ate th e ir ef­ has th e best in fo rm atio n .” . . . forts. Specifically, th e interview s dealt with DAVID S. CLARY, DDS th e p otential im pact o f restorations on th e NAPLES, FL p erio d o n tiu m . □ Comment: D r. Clary’s letter provides us T h e p erio d o n tiu m can d eterio rate to w ith th e o p p o rtu n ity to state th a t ih e Em ­ such an ex ten t th a t tre a tm e n t is d o n e best p h a sis s e c tio n o f J A D A — a l o n g w ith by a specialist, th at is, th e p eriodontist. We th e P erspectives, R ep rise, a n d L etters m u st c o n s id e r th a t th e n e x t p h ase o f sections— do, in fact, carry opinions. T h e tre a tm e n t in th e sam e p atien t m ight neces­ sitate f u rth e r care by a specialist. I f this is disclaim er fo r Emphasis states th a t th e th e case, th e tra in e d p ro s th o d o n tis t is opinions exp ressed o r im plied are those o f ro u tin e ly solving th e special p ro b lem s th e in te rv iew p a rtic ip a n ts a n d d o n o t necessarily reflect th e op in io n , official pol­ id en tified in th e article. T h e p ro sth o d o n tist sho u ld expect re ­ icy, o r position o f the A m erican D ental ferrals fro m g eneral dentists fo r providing Association. tre a tm e n t with fixed an d rem ovable prostheses on extrem ely com prom ised tissues, A d d itio n to p a tie n t h isto r y ju s t as th e p erio d o n tist should expect re ­ ferrals fro m the g eneral d en tist fo r p e ri­ □ I believe it is necessary to resp o n d to od o n tal tre a tm e n t o f these sam e tissues. D r. F ra n k M c C arth y ’s article , “A new T h e p o in t is, in special situations, both the patien t-ad m in istered m edical history d e ­ p erio d o n tal tre a tm e n t an d th e tre a tm e n t v e lo p e d fo r d e n tis tr y ” (O c to b e r). A l­ w ith prostheses may go beyond the scope th o u g h th e re are m any referen ces to a va­ o f th e g en e ral dentist. In th e best interests riety o f cardio p ath ie conditions th a t m ight o f th e patients, tre a tm e n t by train ed p ro s­ affect th e m an ag em en t o f th e d en tal p a ­ th o d o n tists m ust rem ain an option. tient, it seems a p p ro p ria te and tim ely to R e sto r a tiv e r e fe r r a l

NOEL D. WILKIE, DDS ROCKVILLE, MD

□ In resp o n se to theEmphasis article, I am a little d isap p o in ted . M uch o f the in fo rm a­ tion was tru e , b u t som e p o rtio n s w ere ju s t clinical o b serv atio n s. As m o d e rn clini­ cians, we m ust be careful w hen citing ob­ servations, because clinical ju d g m e n t told 10 ■ JA D A, Vol. 112, Jan u ary 1986

ex p an d th a t list to include m itral valve p ro ­ lapse. Since the ad v en t o f the ech o card io g ram a n d o th e r diag n o stic m odalities, it has been fo u n d th a t m itral valve pro lap se may affect 5% o f th e US p o p u la tio n .1 The A m erican H eart Association c u r­ rently recom m ends antibiotic prophylaxis fo r the patients with m itral valve p rolapse

with insufficiency.2 O u r ex p erien ce has been th at th e m ajority o f physicians we have co n tacted will opt for prophylaxis, reg ard less o f th e p resence o r absence o f insufficiency. As den tists, we are in an extrem ely vul­ n erab le position. In my ex p erien ce, a sig­ nificant p ercen tag e o f p atients answ ering history fo rm s sim ilar to the one p resen ted will n o t v o lu n te er a history o f m itral valve p ro lap se unless specifically asked. Most o f these patien ts say, “I d id n ’t th in k it was im p o rta n t” o r “My physician told m e that it was harm less an d n ot to w orry ab o u t it.” I f we an ticipate the creation o f a tra n ­ sient b acterem ia from d en tal treatm en t, caution sh o u ld be exercised if m itral valve p ro lap se h as been diagnosed. STEVEN KAHN, DDS CHICAGO 1. Jeresaty, R.M. Mitral valve prolapse, an update. JAM A 254(6):793-795, 1985. 2. Council on Dental Therapeutics. Prevention o f bacterial endocarditis: a com m ittee rep o rt o f the American H eart Association. JADA 110(1):98-100, 1985.

A n tib io tic m a n a g e m e n t □ D ental p atients w ho have rep lacem en ts fo r m ajor jo in ts o ffe r th e d en tal a n d o r­ th o p ed ic professions with several signifi­ cant m an ag em en t problem s. Is antibiotic pro p h y lax is need ed to p rev e n t infection o f th e jo in t re p la c e m e n t se co n d a ry to tran sien t b acterem ia resu ltin g from d en tal p ro c e d u re s? W hat antibiotic sh o u ld be used if p rophylaxis is indicated? W hen s h o u ld th e p ro p h y la c tic a n tib io tic be started an d fo r how long should it c o n ­ tinue? W hat dosage o f antibiotic should be given? Can chronic o r acute oral infections