The risk of infection amongst any form of implantable medical device is one every patient who receives them takes on. Because medical devices are composed of a variety of synthetic materials, their surfaces can become colonized with bacteria which the body can have a very difficult time eradicating. Such bacterial inoculation may ultimately lead to a full-blown infection and require the implant to be removed.
Most bacterial contamination occurs at the time of surgical implantation. This is the most opportune time for skin bacteria, such as staph, to become accidentally attached to the implant. This probably occurs more than we realize in surgery but the use of IV and irrigation antibiotics helps considerably in washing off and killing bacteria before it becomes a problem.
But there is another potential bacterial exposure opportunity…and that occurs long after the implant has been surgically inserted. That is when bacteria are introduced into the bloodstream through secondary events, such as additional surgery, which may then attach themselves to a synthetic surface as they flow past it. While some implant infections months to years later have undoubtably been caused by such bacteremic events, they are not very common.
As it relates to plastic surgery, the most common medical device inserted is breast implants in women. And the most common event that can cause bacteremia is going to the dentist, particularly when one is having their teeth cleaned. Teeth cleaning, known as periodontal scaling, definitely causes bleeding as almost anyone can testify. This has lead to concerns amongst some breast augmentation patients about the need for oral antibiotics right before going to the dentist or whether should be taken afterwards.
The general consensus amongst plastic surgeons is that patients with breast implants do not need to take antibiotics before or after a dental procedure. But that question has been further answered by a January 2010 article in the Clinical Infectious Diseases journal. In this report, the authors asked that very question as it relates to hip replacements in orthopedic surgery. Their results showed that hip replacement patients were no more likely to develop implant site infections after dental treatments than those who had not undergo dental treatment over a similar postoperative time period.
Hip replacements are a good test for this potential association because these patients are much older than the typical breast augmentation patient and require more advanced or invasive dental procedures due to declining oral health. With no evidence of dental treatments leading to joint replacement problems in orthopedic surgery, it can be assumed that such findings translate to breast implants. With tens of millions of patients with breast implants and hundreds of millions of dental treatment exposures in this population, one would expect such events to become apparent even if they were few in number. But they have not been seen and the breast augmentation patient can now be definitely reassured. One will now have to find another reason to justify not visiting the dentist on a regular basis.
Dr. Barry Eppley
Indianapolis, Indiana