Making a difference through synergy

People frequently ask me why I am so active in my involvement with the state dental association. It’s a good question. I don’t get paid for it, and it takes a lot of time out of my schedule, something that is tough when you are a new dentist. However, the ultimate answer is best told through an experience that I have had that spanned all three levels of the tripartite.

Dr. Manzanares

I have long struggled with the concept of antibiotic prophylaxis. It seemed to go against everything that we have been taught about the use of antibiotics, and it seemed arbitrary in the circumstances in which it was required. Nevertheless, on solely a medical-legal basis, I followed the ever-changing recommendations.
One day, things really changed for me. I had a patient who had a failed knee transplant call up and tell me that his orthopedic surgeon said that the joint failed because of a dental infection. The patient came in, and had an immaculately healthy mouth. There was absolutely no infection to speak of — the surgeon had no basis for his claim. This situation was resolved without incident, but it led me to wonder something: If the orthopedic surgeons were willing to scapegoat us for their failures, why didn’t they ensure that the patients were free of infection or dental disease before they operated?

I asked that question at a meeting of my local dental society — the Albuquerque District Dental Society — and found that no one had a good answer. At the time, I was a delegate to the New Mexico Dental Association House of Delegates, the governing body of my state dental association. I wrote a resolution asking that we petition the ADA to study this issue, and, if appropriate, issue guidelines to the orthopedic surgeons requiring a dental clearance prior to joint replacement surgery. During deliberations in the House, this resolution was expanded to explore what medical procedures required dental health optimization. Our ADA delegates then took this resolution to the ADA House of Delegates, where it passed and the Council on Scientific Affairs was directed to explore this issue. The council convened several expert panels and did a great deal of research on this topic. I recently spoke with Dr. Marcelo Araujo,  Ph.D., vice-president of the ADA Science Institute and our Association’s head scientist, who told me that this is one of the most important projects that he’s ever worked on and that the first paper will be released in 2019, concerning dental clearance for cardiac issues. He also said that future manuscripts are under preparation and will be released in the upcoming years. This process isn’t fast — the original resolution was submitted five years ago — but ensuring that the ADA issues proper recommendations is more important than doing something that is quick but inaccurate.

This project came about from a question asked by a new dentist who was working on a patient who was covered by Medicaid in rural New Mexico. It was improved by the contributions from dentists at the local, state and national levels of the ADA. And hopefully, it will help our profession demonstrate the importance of oral health to our colleagues in medicine. Despite what my mother might say, I’m not that special. Every single dentist has ideas that could improve the profession. They are the things that we talk about when we go out to dinner with our colleagues. They are the things that frustrate us as we drive to and from the office each day. Involvement in our Association can foster these important discussions and help make these ideas into a reality.

So why am I so active in the dental association? Because we can make a greater difference in our profession and the patients we serve when we work together than we ever can when we work alone.

This editorial, reprinted with permission, first appeared in the 2019 winter edition of the New Mexico Dental Journal. Dr Manzanares is a general dentist from Albuquerque, New Mexico. He is the secretary-treasurer of the New Mexico Dental Association and serves on the ADA Council on Communications.

2 comments

  • Nicely written and great points! We all can make a difference; we have to speak up and let our curiosity lead us.

  • While growing up, I had to take a dose of antibiotics prior to dental work due to mitral valve prolapse, even for routine prophys. I was very happy when the guidelines were finally altered. You are doing a great deed getting these rules changed to some that make more sense. It should be mandatory to have dental clearance prior to any orthopedic surgery, and those surgeons should know to make it part of their normal preoperative routine.

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