Richard V. Dowden, M.D., C.M., F.A.C.S.

Certified by the American Board of Plastic Surgery

Cosmetic and Plastic Surgery, Inc.
6770 Mayfield Road, Suite 410
(Mayfield Heights) Cleveland, Ohio 44124
(440) 449-7470

Answers to Frequently Asked Questions about
breast enlargement:

Should implant patients take antibiotics for dental cleaning?

It is your choice! Read on.

The chance of implant problems from dental cleaning without antibiotics is VERY small. You could probably have a hundred cleanings without antibiotics, and have no problems. Having breast implants does not increase your chance of an infection from dental cleaning - it just means that the consequences could be more of a problem if you did get an infection.

People who have heart-murmurs, or who have man-made medical devices such as pacemakers, hip-joints, penile implants etc, are advised to take antibiotics when they have dental cleaning or gum surgery performed. The reason is that work on the gums, or gum infections, causes bacteria to enter the bloodstream. Those bacteria could go anywhere, and can end up in any part of the body, only rarely causing infection.

If an infection were to start around a medical device, it might have to be removed. Antibiotics can help avoid that possibility. Not all Plastic Surgeons have their patients take antibiotics in these situations, but I do. A single loading dose before the trip to the dentist is likely enough, so one will not have to worry about a yeast infection occurring.

To give you an idea of how low the chances are, since 1978 I have seen only 11 women get into serious implant problems after unprotected dental cleaning, and that is out of thousands of women getting 2 to 4 cleanings every year, most protected, many not. The 11 problems included: A.Sudden capsular contracture after being soft for many years. B.Infection around the implant that subsided with intravenous antibiotics. C.Infection requiring removal of the implants. There are similar reports of these problems in the medical journals. This may seem excessively precautionary, but I would want the same done if it were me. It should go without saying that anyone who has any infection anywhere must get prompt treatment, especially if they have medical devices inside.

Is it worth it to take antibiotics every time, just to prevent something that may be a one-in-a-thousand chance? Especially with all the discussion these days about bacteria developing resistance and posing a greater risk to society in general? You have to decide for yourself.

At a recent conference of dentists, the dentists decided that it was not necessary for implant patients to take antibiotics for dental cleaning. Unfortunately, there was no one there to present the information from the perspective of the implant patients.

Sometimes people express concern that if they take antibiotics frequently their body might "develop a resistance to antibiotics" or that they might get an overgrowth of other bacteria, called a "superinfection". First, an overgrowth of bacteria requires a fairly long course of antibiotics, more than the few doses used for dental prevention. Second, the body does not develop resistance to antibiotics, (although bacteria can do so) and the chance of that possibility has already been taken into account by the health advisories that advise taking antibiotics for protection of heart valves, hip joints, pacemakers, and penile implants.

Women with implants who are opposed to taking antibiotics for dental prophylaxis often point out that they have had their teeth cleaned dozens or even hundreds of times without any trouble so they see no reason to bother taking them. That is their right, and I do leave it up to the patient to decide. But it should be noted that each of the women whose implants got infected through unprotected dental cleaning had previously had their teeth cleaned dozens of times without any problems also. And then that next time was when they had a problem.

There have been many articles in newspapers about how some bacteria are becoming less susceptible to certain antibiotics, and that is a great concern to all of us for society in general. Even though a single dose of antibiotics is unlikely to have much of an effect upon the resistance of the bacteria around us, it certainly could be assumed to have some effect. Some women, worried about the gradual increase in bacterial resistance to antibiotics, have declared their intention to do their part by refusing to take antibioticsfor implant protection. This is a very generous and unselfish attitude, as they are putting society's interests ahead of their own, and that is commendable. It takes a large dose of courage to have the willingness to look beyond one's own welfare in order to make a sacrifice that might someday benefit others. If a woman chooses to decline antibiotics on that basis, it is her right, and I would never criticize her for making that choice.

If you are undecided about what to do, here is an easy way to get more information from the professionals in your area. Ask both your dentist and your plastic surgeon the following question: "If you yourself had an artificial heart valve, or a penile implant, or an artificial hip joint, would you take antibiotics for dental cleaning?" Listen carefully for their answer, and you will get information to help you decide. Personally, my answer would be "You bet I would." So I can not do less for my patients. It ends up being the patient's call after all. Incidentally, each of the 11 patients now take the antibiotics quite faithfully.

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6770 Mayfield Road, Suite 410
(Mayfield Heights) Cleveland, Ohio 44124
(440) 449-7470

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