The phone is ringing

Doctor: Yes, Dental Surgery, how can I help you?

Patient: Hello, I’d like to talk with a dentist, please?

Doctor: Hello, I’m a dentist. What can I do for you Madam?

Patient: Doctor, I would like to make an appointment at your surgery, however I must warn you right away that I have an artificial valve in the heart.

Doctor: I understand this is not a problem. Remember to bring information about any drugs you are currently taking when you come to my office.

Patient: So, when we can make an appointment?

Doctor: How about Friday at 2 p.m.? Is it suitable for you?

Patient: Of course. I do not work. I’m retired. See you on Friday then! Goodbye!

Doctor: Goodbye!

Friday at 2 p.m.

Patient: Hello, I have an appointment for today at 2 p.m.

Doctor: Hello, come into the office, please, and have a sit in the chair. So what can I do for you?

Patient: Like I said, I would like to have my teeth treated at your surgery. I moved here and your surgery is the closest one.

Doctor: On the phone you have mentioned that you have an artificial valve.

Patient: Well, yes I do. I take special drugs.

Doctor: Well, here is an information card. Please fill it. There are questions about your general health and about the medications you take. I’ll come back in a moment.

After 10 minutes

Doctor: All right. Now I know everything. Today I will take a look at your mouth. I’m not going to probe the pockets.

Patient: Yes, of course. Will there be any treatment today?

Doctor: No, there won’t. Today I would like to just explore.

After the examination

Doctor: Well, yes. You have a lot of plaque on the teeth, which should be removed. I’ll take care of it during the next visit. There is also one tooth for root canal treatment and two cases of tooth loss. During the next visit I will deal with all these. Please, take a pantomogram and a single image of this particular tooth. I give you also a prescription for an antibiotic. Take one pill an hour before the next visit, please. Without this, I will not be able to perform the procedure, and the plan is to remove the tartar, and to start root canal treatment.

Patient: Yes, I know. I had to take antibiotics once before. This was before tooth extraction. I was then at my family doctor, who told me then to set aside my blood-thinning medications.

Doctor: Now I do not need you to discontinue treatment. There will be performed procedures but not the ones involving too much blood. Besides, before starting treatments involving the tissues breaking or discontinuation we will have consider whether the medication should be stopped or not.

Patient: I see. So, when can I come, Doctor?

Doctor: In a week time, at the same time. Please, here is a piece of paper with the date of your next appointment. Please, just do not forget about taking X-rays – here is a referral letter and be sure to take an antibiotic.

Patient: Of course. Thank you very much. Goodbye.

Doctor: Goodbye.

VOCABULARY PRACTICE

Match terms with definitions

adverse     reactions     infective endocarditis     regimen     pathogen     trigger     bacteraemia  
underlying cause     prophylaxis

1. ___________ – a systematic plan of diet, therapy, or medication which was designed to improve and maintain the health of a patient.
2. ___________ – to cause
3. ___________ – measures designed to preserve health and prevent the spread of disease.
4. ___________ – undesirable effects.
5. ___________ – a specific causative agent (as a bacterium or virus) of disease or condition.
6. ___________ – an infection that can seriously damage heart valves and cause other serious complications if it is not treated quickly with antibiotics.
7. ___________ – basic/fundamental factor or reason for something.
8. ___________ – presence of bacteria in blood.

Read the text below. Complete the gaps with words from the table

Many patients are told that they need to take an antibiotic before having a dental, surgical, or other 1)................. medical procedure.

Certain procedures, such as a root canal treatment or tooth extraction, may allow bacteria from the mouth to enter the 2)............... Rarely, these bacteria can infect the heart valves and lining of the heart, causing 3).................. This inflammation is called infective endocarditis (IE). IE has the potential to cause catastrophic medical problems, including heart failure and leakage of the heart valves.

When taken 4).............. to a procedure, antibiotics may prevent bacteria from being released into the bloodstream. This is known as antibiotic 5)...........................

Preventative antibiotics are recommended for high-risk patients undergoing dental procedures that involve manipulation of the tissue of the gums, the periapical region of the teeth, or 6)................. of the lining membranes of the gums such as tooth extractions, routine dental cleaning (7)...................), or drainage of a dental abscess.

Anyone who is 8).................... of developing IE should have a professional cleaning every six months, brush teeth twice a day, and do daily 9)................... These 10)............... can help to prevent plaque and bacteria from building up around the gums and teeth.

People who are at highest risk for infective endocarditis (IE) should take one dose of an 11).............. antibiotic (pills or liquid) one hour before certain dental or oral procedures; a second dose is not necessary.

People unable to take oral medications can be treated with an antibiotic 12)............... 30 minutes before the procedure.

Read these sentences connected with a subject of antibiotic prophylaxis in patients at risk of infective endocarditis. Are the sentences true or false?

1. Bacteria in the mouth may trigger endocarditis in people at higher risk, however it’s uncommon. T/F
2. In case of endocarditis bacteria which enter through bloodstream (for example through bleeding gums) may affect inner lining of heart i.e. valves. T/F
3. In most cases, the risk of problems from antibiotics exceeds the benefits from preventive antibiotics. T/F
4. Patients with moderate as well as patients with high risk of infective endocarditis should receive antibiotics prophylaxis. T/F
5. Having an artificial cardiac valve is a criterion for prescribing antibiotic prophylaxis in dental patients. T/F
6. Antibiotic prophylaxis is also recommended in patients who require adjustment of orthodontic appliances or placement of orthodontic brackets. T/F

Lesson 65 - answers