The standard of premedicating patients with a heart murmur with an antibiotic came under scrutiny when the medical community noted an increase in resistant strains of bacteria. A concern arose that low-dose antibiotic treatment could encourage these resistant strains. As a result of extensive research done jointly by the dental and medical professions, the standard of care changed dramatically.
"What they found was that there is no discernable link between the risk of developing endocarditis as a result of dental treatment," says Orzechowski. "So the policy was changed to reflect that. Now the only patients who receive an antibiotic prior to dental treatment is someone with an artificial heart valve, or anybody with a history of endocarditis."
Further, Orzechowski noted that the dental community realized that the bacteria responsible for inflammation of the heart tissue could easily have been introduced in a patient's home and not at the dental office.
"You could put bacteria into your blood stream through your gum tissue by brushing your teeth aggressively," he says. "Someone with bad gum disease, who has swollen, inflamed, bleeding gums, they may be creating a bacteremia every day."
The policy change was critical, says Orzechowski, because it protected dentists and oral surgeons on the legal front.
"The other component is the whole liability issue," he says. "As much as we all suspected that [premedication] really wasn't necessary, nobody in their right mind would take it on their own to stop prescribing an antibiotic if the standard of care is that you use an antibiotic. So, it takes the profession, and in this case a joint effort between the medical community and the dental community, to look at those things as objectively as possible. And then if they feel the policy needs to be changed, then they create a position statement that says that."