وسأتحدث هنا عن أهم المخاطر التي قد تحدث في عيادة الأسنان وكيفية معالجتها ومنع حدوثها.
الزيارة الأولى
أمراض القلب وطب الأسنان
وتشمل تلك العلاجات السنية تنظيف الجير وعلاجات اللثة وخلع الأسنان وعلاج أعصاب الأسنان، إضافة إلى بعض أوجه علاج التقويم. ولذلك عملت منظمة القلب الأميركية على إصدار بروتوكول لكيفية التعامل مع المريض المصاب بتلك الأمراض في عيادة الأسنان. ويتلخص ذلك البروتوكول في وصف مضاد حيوي لمريض القلب لأخذه قبل زيارة طبيب الأسنان بساعة تقريبا، وجرعة أخرى بعد الانتهاء من تلك الزيارة. وكان هذا البروتوكول هو المتبع في معظم عيادات الأسنان إلى أن تم استصدار بروتوكول جديد (2007) الذي تم الاعتراف به من قبل الجمعية الأميركية لطب الأسنان.
وقد حمل ذلك التقرير في طياته أخبارا سارة ألا وهي أن ليس كل المصابين بأمراض القلب يحتاجون لمثل ذلك الغطاء بالمضاد الحيوي قبل وبعد زيارة طبيب الأسنان وذلك استنادا على دراسات تم عملها أخيرا، وتتلخص نتائجها في أن أخذ جرعة المضاد الحيوي قبل زيارة عيادة الأسنان لا يمنع الإصابة بالتهاب الغشاء الداخلي للقلب لمرضى القلب المشار إليهم أعلاه. هذا بالإضافة إلى أن قلوب أولئك المرضى سهل الوصول إليها من قبل بكتيريا الفم من خلال النشاطات اليومية للفم وخاصة في ظل وجود لثة ملتهبة وجير متراكم على الأسنان. كما أن أضرار استخدام المضادات الحيوية في هذه الحالة يفوق الفوائد الناتجة عن استخدامها. ومن تلك المضار التي تحدث عنها التقرير الأخير، حساسية بعض الناس لبعض المضادات الحيوية مثل البنسلين التي قد تكون قاتلة أحيانا. وكذلك قد تكتسب البكتيريا مناعة ومقاومة لتلك المضادات مع كثرة الاستخدام، وبالتالي تصبح عديمة الفائدة عند استخدامها.
توصيات جديدة
المصابون ببعض أمراض القلب لا يحتاجون إلى أخذ مضاد حيوي قبل وبعد زيارة طبيب الأسنان.
- أمراض الصمام الميترالي
بعض مشاكل القلب الأخرى لا تزال تحتاج إلى تلك الجرعة الوقائية،
- صمامات القلب الصناعية
عزيزي مريض القلب:
وأنا أنقل هنا ما تم نشره من قبل الجمعيات المختصة في مثل هذا المجال مثل المنظمة الأميركية للقلب والمنظمة الأميركية لطب الأسنان. وتذكر أن زيارة طبيب القلب قبل زيارة طبيب الأسنان مهمة جدا للتأكد من احتياجك لتلك الجرعة الوقائية أثناء زيارة طبيب الأسنان من عدمها.
Diagnosis of Heart Infections: Bacterial Endocarditis
What is bacterial endocarditis
A child with an existing heart problem might get bacterial endocarditis while having an operation or dental treatment that causes bleeding. Usually, a child’s body can kill the bacteria, and he does not get sick. But if blood does not flow through your child’s heart or valves smoothly because of heart problems, your child is more likely to get bacterial endocarditis. It is more likely to occur in children with complex cyanotic defects, shunts, and artificial heart valves.
While the chance of getting this infection is low, knowing how to prevent it is important, since it
?What causes bacterial endocarditis
Bacteria get into the bloodstream and lodge inside the heart. The bacteria can sometimes get into the blood after an operation or dental cleaning that causes bleeding.
What are the signs of bacterial endocarditis?
· a slight fever of 37.5°C to 38.5°C that you cannot explain and that lasts for 5 to 7 days
· sweating
· loss of appetite
· pain in the muscles and joints, such as the knees, shoulders, or knuckles
· loss of weight
· a skin rash
· headaches
· a general feeling of weakness
The signs of bacterial endocarditis are like the signs of the flu. You may find it hard sometimes to know if your child has bacterial endocarditis. If your child has some of these signs and they do not go away, have your paediatrician or family doctor check your child.
How does bacterial endocarditis affect the heart and body?
The bacteria that get into the heart will grow and cause large pieces of “vegetation” to form. This can damage the part of the heart where the bacteria are growing. Also, these chunks of vegetation can break away from the heart's surface and move into other parts of the body, like the lungs, potentially causing blockage, which can be damaging.
How is bacterial endocarditis diagnosed?
There are tests that can help the doctors find out if your child has bacterial endocarditis:
· blood tests to check for bacteria (your child may need to have several blood samples taken at different times)
· a urine test, which tests your child’s urine for the blood and inflammation that can accompany endocarditis
· an echocardiogram, which is a recording of the positions and movement of the walls of the heart or the parts inside the heart, such as the valves
How is bacterial endocarditis treated?
If your child has bacterial endocarditis, the doctor will give him antibiotics through an IV. Your child may need antibiotics for as long as 6 weeks or more. He may need to stay in the hospital or be treated at home by nurses from a home care service for part of the 6 weeks. For more serious cases, surgery may be needed.
What are the long-term outcomes of bacterial endocarditis?
With early diagnosis and aggressive intervention, outcomes for children who develop bacterial endocarditis are generally positive. Left untreated, this infection can be fatal. Preventing it from occurring is the main goal.
How can bacterial endocarditis be prevented?
You can prevent your child getting bacterial endocarditis by taking these simple steps.
Take good care of your child’s teeth. These instructions will help you keep your child’s teeth healthy and avoid infection in the mouth.
· Start early. Get your baby used to having a clean mouth. Wipe his gums gently with a damp face cloth after every feeding. This will help your baby get used to having his gums touched, and they will become less sensitive. You should start wiping his teeth as soon as your baby gets them. This starts when your baby is about 6 months old. Usually, you can use a toothbrush to clean your baby’s teeth when he is 1 year old.
· Do not let your baby or child sleep with a bottle of milk or juice. A bottle of water is okay because it does not have sugar that can cause cavities. Breastfeeding or bottle-feeding on demand, which means when your baby wants it, can also cause cavities. You should clean your baby’s teeth after you breastfeed or bottle-feed your baby.
· If your baby usually falls asleep right after the last breastfeeding or bottle-feeding, make sure you clean his teeth just before you give him this last feeding.
· Do not use toothpaste to clean your child’s teeth until your child is 2 years old. Too much fluoride may harm your child’s teeth. Your young child needs only a little fluoride. Use infant toothpaste with very little fluoride. While your child is between 2 and 6 years old, he should use toothpaste only in very small amounts, or use a toothpaste with little fluoride. (Fluoride is a mineral in toothpaste that helps keep the teeth healthy.)
· Make sure your child brushes his teeth after every meal and snack. Your child should also brush his teeth after taking liquid medicine. Liquid medicine may have a lot of sugar that needs to be cleaned away.
· Get your child to start flossing his teeth when his back teeth touch each other. Your child will need help flossing until he gets used to doing it. Make sure your child flosses the teeth that touch each other. A toothbrush cannot clean between these teeth. During a visit to the dentist’s office, ask the dentist to show your child how to floss properly.
· Take your child to the dentist for regular check-ups and make sure you tell the dentist about your child's heart condition.
· Make sure your child takes antibiotics before any treatment that may cause him to get bacterial endocarditis. Before a potentially infective procedure, your doctor will tell you whether your child needs antibiotics. Situations that could potentially put your child at risk include:
· Some operations, such as having the tonsils or the adenoids taken out (Tonsils are round pieces of tissue at the back of the mouth beside the tongue. Adenoids are like tonsils, but they are out of sight up behind the nose.). Taking antibiotics also applies if your child will be having a G-tube put in or having a bladder test.
· Some deep cuts, particularly if they need stitches or look infected.
· Some work on the teeth (for example, having a tooth taken out, cleaning the teeth in the dentist’s office, fillings near the gums, or when braces are put on for the first time).
· Some body piercing. Check with your child’s cardiologist.
· Some children with heart problems may need to take antibiotics for the rest of their lives to prevent bacterial endocarditis. If you are not sure if your child needs antibiotics, ask your child’s doctor.
· Get your child a Medic Alert bracelet, if he needs one. Your child may need a medic alert bracelet, which is a special bracelet that says what your child’s condition is. This bracelet helps a doctor know what special treatment your child may need when there is no one to speak for him. Ask your cardiologist if your child needs a medic alert bracelet. It is much better to prevent bacterial endocarditis than to treat it.
http://www.aboutkidshealth.ca/
