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Why Some People Take Antibiotics Before Visiting The Dentist

Dentists prescribe prophylactic (to prevent the spread of disease) antibiotics before dental treatment for people with certain medical conditions. The American Heart Association, the American Dental Association, and the American Academy of Orthopedic Surgeons have recommended the guidelines for preventive antibiotics for these medical conditions. The current guidelines were developed for patient well-being, as well as in consideration of the current concern regarding the overuse of antibiotics. The guidelines outline specific medical conditions and provide examples of which dental procedures indicate the need for prophylactic antibiotics.

The risk of infective endocarditis (infection and inflammation of the lining of the heart and its valves) is increased with dental procedures that cause bleeding and the potential release of oral bacteria into the bloodstream of people with certain medical conditions. Individuals who have certain congenital or acquired heart defects, as well as some conditions or abnormalities of the heart, have an increased chance of a bacterial infection.

The link between dental procedures and infective endocarditis is controversial. Not all dental procedures require the use of antibiotic prophylaxis. Dental procedures that have minimal potential to cause bleeding are considered low risk for infective endocarditis. Antibiotic prophylaxis may be indicated for invasive dental procedures that are likely to cause bleeding and release of oral bacteria in the bloodstream.

Also, the release of oral bacteria into the bloodstream appears to increase the risk of developing an infection around a prosthetic joint in people with a depressed immune system. Use of prophylaxis antibiotics is recommended for individuals with total joint replacements who have certain other health conditions.

Antibiotic prophylaxis also can be prescribed for circumstances other than prevention of infective endocarditis and prosthetic joint infections. Some other conditions or situations that may indicate antibiotic prophylaxis include in-dwelling catheters, hemodialysis patients with arteriovenous shunts, shunts for hydrocephalus, oral surgical or operative procedures (depending on the patient's immune system), insulin-dependent diabetes, or diabetics whose disease is poorly controlled.

By Denise J. Fedele, DMD, MS

Dental Information, The Costs Associated With Root Canal Treatment

What are the Costs Associated with Root Canal Treatment?

There are many factors that affect the costs and payment associated with root canal treatment. Each patient and tooth presents a different set of circumstances. Generally the cost of root canal treatment is directly related to the chair time necessary to perform the treatment as well as to the costs of the dentist staff, training, and technology that the dentist has available when performing the procedure. Be sure to ask your dentist about dental financing credit, dental treatment financing, or if there is a possible loan for dental work available.

There are many factors that influence the amount of chair time necessary to treat any particular tooth:

• The position of the tooth in the mouth.
• The number of roots and the number of canals within these roots.
• Root curvatures and the length of the roots.
• The presence or absence of calcifications within the root canal space.
• Special dental considerations. For example, it may be more difficult for the dentist to work through an existing crown or a bridge than to work on a tooth with only a small previous filling. Also, some teeth may have been severely broken down by past dental disease and these may have to be "built-up" before root canal treatment can even be started so that an aseptic field can be established and maintained during treatment.

In addition to the chair time involved for treatment, other factors are also taken into consideration when determining a fair fee for root canal treatment:

• The cost of technology. Dentists who use state-of-the-art technology for certain procedures have invested in microscopes, computer digital radiography, ultrasonics, and specialized training courses for themselves and for their staff. The costs of these items are shared by those patients who benefit from them.
• The costs of the dental office overhead include staff, rent, and supplies in addition to many other expenses. These costs vary significantly in different areas of the country.
• Fees vary among practitioners due to differences in their endodontic treatment philosophies, which in turn dictate the chair time required, the materials selected, and the technologies utilized.

In conclusion, there can be marked discrepancies in the fees charged for root canal treatment by different dentists. Ultimately, the best value for care is treatment that is done once and works over a period of many years. Conversely, the most expensive dental treatment is the treatment that may cost less initially but does not work predictably and needs to be redone one or more times. The wise dental consumer does not make a treatment decision on the basis of cost alone.

Will Insurance Cover the Cost of Root Canal Treatment?

Dental insurance will usually help with a portion of the endodontic treatment fee. A variety of dental insurance plans are available. A specific benefit package is selected contractually by each employer for the benefit of the employees. Some benefit packages may restrict or not recognize certain procedures, while in other instances the yearly maximums are unrealistic for anything other than the most basic care. The dentist will make a professional judgment and treatment recommendation based on what is best for the patient, not on what is best for the for-profit insurance company. The total fee is the patient's responsibility but the dental office will work with the insurance carrier to get the maximum contracted benefit. The patient should speak with the dental treatment coordinator before treatment begins in an attempt to estimate the available insurance benefit. Be sure to ask your dentist about patient financing, dental treatment financing, dental credit cards, or if there is a possible loan for dental work available.

by Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

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