April, 2004 Newsletter


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April, 2004 Newsletter

  1. 1. United States Public Health Service  DENTAL NEWSLETTER A publication of the Dental Professional Advisory CommitteeVolume IV, Issue #1 (Issue #12 overall) April 15, 2004 In this issue of the USPHS Dental Newsletter: Click on the titles below to go directly to the articles.COVER STORYPHS dentists deploy in support of war The Dental Professional Advisory Committee is pleased to announce that the USPHS Dental Category Home Page is now available to all USPHS dentists.REGULAR SECTIONSChief Dental Officer’s column – Pg. 2 After months of tedious work by both CDR Jim Webb and CDR Arlan Andrews,DePAC Chair’s column – Pg. 2 the new and improved web page features more basic information, more links,DePAC Vice Chair’s column – Pg. 3 more career development information, and improved graphics from the previousAgency Updates – Pg. 4 web page.Organizational Updates – Pg. 6 All dentists are encouraged to view this webpage (click this link to go directly toFEATURES it, or go to: http://www.phs-dental.org/depac/newfile.html). If you haveJunior Officer Profile – Pg. 8 comments about the web page, contact the webmaster.Senior Officer Profile – Pg. 8Question of the Month – Pg. 9Clinical Perspectives – Pg. 10 Selection and Use of Antibiotics – Pg.10 Antibiotic prophylaxis – Pg. 12Deployment pictures – Pg. 15 In support of the war effort, USPHS dentists have been deployed over the past few months to 29 Palms, the Marine Corps Air Ground Combat Center (MCAGCC), and to the US Marine Camp at Camp LeJeune, North Carolina.The USPHS Dental Newsletter is now The following officers were deployed to Camp LeJeune during the time periodpublished 6-8 times annually, and is distributed of 29 October 2003 – 28 February 2004: CDR Dean Coppola, LCDR Charleselectronically through the USPHS Dental Webber, LCDR Scott Trapp, CDR Lawrence Gaskin, CDR Hiro Nakatsuchi,Bulletin Board, agency distribution lists, and the LCDR Robin Scheper, CAPT Thomas Bermel, CDR Pedro Perez, CDR LisaUSPHS Dental Directory. Cayous, LCDR Aaron Means, CAPT Shawneequa Harris, CDR Renee Joskow, CDR Jose Rodriguez, LT Kathryn Bagg, LCDR Robert Lloyd, and LCDR LauraThe next issue of the newsletter will be Lund.published in early June 2004. The deadline forsubmitting articles is May 15, 2004. The following officers were deployed to 29 Palms during the time period of 4 January – 27 March 2004: CDR Luis Garabis, CDR Randall Mayberry, CDRIf you have suggestions or comments about this Mark, McDowell, CAPT Lee Shackelford, CDR David Crain, LT Bleuel, CDRnewsletter, or would like to submit an article, Elmer Guerrero, LCDR Jeffrey Roth, CDR Dan Huber, CDR Edward Arnold,please contact the Editor. If you would like to LCDR Kelly, CAPT Gary Pannabecker, CDR Steve Torna, LT Kaci Solt, CDRcomment on organizational or agency reports, Steven Florer, LT Morazan, LCDR Dickert, CDR Tania Macias, CAPT Samuelcontact the Section Co-Editor. If you have Bundrant, CAPT Jeff Carolla, and CDR Paul Krispinskycomments or suggestions regarding clinicalarticles, contact the Clinical Perspectives Co-Editor. ►See deployment pictures, page 15
  2. 2. Page 2 USPHS Dental Newsletter April 2004 Dushanka V. Kleinman, D.D.S., M.Sc.D. Assistant Surgeon General The early stages of the Transformation of the Corps are in full swing and it is timely to provide active and constructive input into the process. While organizational functions and delegations of authority for the management of Corps operations and policies have been documented (Federal Register, Vol. 68, No. 243, 12/13/03 and on the DCP website), there is still much work to do before the new structure and functions are fully implemented.The Assistant Secretary for Health, the Surgeon General, RADM Knouss, RADM Williams, agency liaisons and agency headshave been holding agency-specific all hands meetings to listen to concerns, answer questions and gain input from officers. Inaddition there is a contract with The Lewin Group, a consulting firm that is conducting a variety of activities for additionalinput for the transformation. I am serving on their billets and missions “policy panel”. They also are conducting a policypanel on hard to fill and hardship billets, a “technical panel” on billet standards and a number of focus groups. These focusgroups will address such topics as input from junior officers on careers and assignments, online website users, user agenciesand input from potential recruits. The latter will reach out to professional associations relevant to each category. I encourageyour input and welcome your questions. Your DePAC is working hard to keep you informed, and I will forward documentsand materials as they become available. Ronald E. Bajuscak, D.M.D., M.S. CAPT, USPHSThis is a time of change that we are seeing as we go through the transformation of the Com-missioned Corps. These changes will be continuing to develop and will occur over thenext few years. As with any company or corporation, changes create both excitementand panic at the same time. But before we panic too much, I think it is most importantthat we remember who we are and what we do. We are a group of extremely conscientious healthcare members thatprovide a service to a part of the nation that truly needs our care and that the average healthcare provider would not andcould not handle. It is a skill far beyond clinical hands-on and requires dedication, commitment and compassion. Weprovide so much both clinically, administratively and scientifically that in many ways we are not truly replaceable.Keeping this in mind, we should embrace the changes that our Surgeon General is establishing. Certainly there is fullintent to make us a better organization that can utilize the many facets of abilities we have and demonstrate daily. I amreminded daily by the many communications I receive, that we are an extremely talented group of dentists, health leaders,researchers and diplomats whose skills far exceed clinical dentistry only. I look forward with excitement at what newthings we will accomplish and know we are the true leaders of oral health care in this wonderful nation.
  3. 3. Page 3 USPHS Dental Newsletter April 2004 Gary L. Pannabecker, D.D.S. CAPT, USPHSOne of the common themes identified by PHS dentists from the recent DePAC Dental Category Survey was a lack ofawareness of the duties, purpose, and objectives of the Dental Professional Advisory Committee (DePAC). Well, believeit or not, new DePAC members have often expressed that same ambiguity. The ongoing transformation and restructuringof DCP has contributed to a need to clarify the role and vision of DePAC. To meet this need, RADM DushankaKleinman, along with the DePAC leadership, supported and organized a retreat January 14-16, 2004 held at the BolgerCenter for Leadership Development in Potomac, Maryland. The retreat facilitator, Preston Littleton, D.D.S., M.S., PhD.,RADM USPHS (ret), interviewed DePAC members prior to the retreat to help clarify its goals and objectives, whichwere: 1. To develop a common understanding of the Dental Category problems, issues, and opportunities as identified by DePAC members, 2. To develop a common understanding of problems, issues, and opportunities as identified by the Secretary, Surgeon General, the Chief Professional Officer’s Board, and the Chief Dental Officer, 3. Increase the effectiveness and efficiency of the DePAC and ability of its members to work as a team, 4. Ensure the orientation of new members and a common understanding by all members of their responsibilities and accountability for service on the DePAC, and 5. To develop a Category-specific strategic plan with a clearly identified one year agenda.In addition, RADM Kleinman stressed the need to concentrate on addressing how we can reach out to all members of thePHS Dental Category, including civil service, Commisioned Corps, tribal-hire, and contract dentists.The action plan for DePAC 2004 that resulted from the effort at the retreat includes the following: 1. Provide advice, assistance to the Chief Dental Officer. The rapid transformation has increased the demand for such input. 2. Improve communications with all PHS dentists (i.e., the entire dental category). DePAC believes that accurate and focused communications with the dental category will also prompt improved input from the dental category, so DePAC can be as informed as possible about PHS dentists’ concerns. 3. Develop a guide, booklet to provide recent hire and mid-career PHS dentists answers to common questions and information regarding career options, advancement. 4. Expand the existing mentoring program to include civil service, tribal-hire, contract dentists to provide assistance, support to new dentists. 5. Develop orientation program for new DePAC members. DePAC membership is for a 3-year term. An orientation program is needed to shorten the learning curve so 1st year members can immediately become involved and contribute.DePAC encourages input from all PHS dentists regarding concerns, issues, and ideas for additional services and supportthat DePAC may provide the dental category.The earnest participation by all DePAC members, expert facilitation by Dr. Littleton, and outstanding leadership by thecurrent DePAC Chair, CAPT Ron Bajuscak, and Past- DePAC Chair, CDR Dan Hickey resulted in a very productive,worthwhile retreat. Links of Interest (click on link) USPHS Dental Category Home Page Division of Commissioned Personnel 2004 Dental Professional Advisory Committee Roster USPHS Dental Listserv Home Links to USPHS and Dental Organizations Links to previous newsletters
  4. 4. Page 4 USPHS Dental Newsletter April 2004 New NIH Initiative: “Roadmap for Medical Research” Kleinman will continue in her role as Chief Dental Officer, USPHS. James Lipton, D.D.S., Ph.D. CAPT James Lipton, NIDCR, serves full-time as the CAPT, USPHS Senior Advisor to the Chief Dental Officer, USPHS. This Senior Advisor to the Chief Dental Officer is in response to the increased activities associated with Secretary Tommy Thompsons transformation of theOn September 30, 2003, Dr. Elias Zerhouni, Director, Corps. Dr. Lipton is a senior commissioned officer andNIH, and the directors of the individual NIH Institutes and has experience with both the regional and central offices ofCenters announced a series of initiatives known the Public Health Service. Additionally, he has served ascollectively as the NIH Roadmap for Medical Research. Chair for the Dental Professional Advisory Committee.These initiatives are designed to transform the nationsmedical research capabilities and speed the movement of CAPT Kevin Hardwick has assumed responsibility for theresearch discoveries from the bench and into practice for NIDCR dental school research infrastructure andthe benefit of the public. curriculum development program. This is in addition to his responsibilities in the NIDCR Office of InternationalDeveloped with input from more than 300 nationally Health. Dr. Hardwick has worked with dental schoolsrecognized leaders in academia, industry, government, and both nationally and internationally at the Health Resourcesthe public, the NIH Roadmap provides a framework for and Services Administration and at the National Institutesthe avenues of exploration that the NIH needs to address to of Health.optimize its entire research portfolio. In setting forth avision for a more efficient and productive system of CAPT Isabel Garcia is the acting director of the Office ofmedical research, the NIH Roadmap focuses on the most Science Policy and Analysis (OSPA) at NIDCR. She wascompelling opportunities in three main areas: new formerly the Special Assistant for Science Transfer,pathways to scientific discovery, research teams of the directing activities to promote science-based practice andfuture and re-engineering the clinical research enterprise. coordinating the implementation of the NIDCR healthTo learn more, click this link: the NIH Roadmap. disparities plan. Dr. Garcia also is the co-director of the NIDCR Dental Public Health Residency. She recently ledIn the Fall and Winter of 2003, Dr. Zerhouni began to the update of the NIDCR Strategic Plan and will beassemble a team to coordinate the implementation of overseeing its implementation as part of her role as therelated activities for the NIH Roadmap. As part of this acting director of OSPA.effort, Dr. Zerhouni asked RADM Dushanka V.Kleinman, Deputy Director for the National Institute of The NIDCR recently announced several exciting new oralDental and Craniofacial Research (NIDCR), to serve in the health research initiatives in clinical, behavioral and basicnew Office of NIH Director position of Assistant Director sciences. These include the development of a general dentalfor Roadmap Coordination, beginning December 15, 2003. practice-based research network to conduct multiple clinicalDuring this initial six-month detail, Dr. Kleinman will trials and prospective observational studies that will answerwork closely with the NIH Roadmap Implementation questions facing general dental practitioners in the routine careCoordination Committee, designated Roadmap liaisons of their patients. Other programs focus on oral complicationsfrom the NIH Institutes and Centers, the to—be-named of HIV infection including oral malignancies and tumors, newSenior Advisor for Clinical Research Re-engineering uses of fluoride to improve oral health and prospective studiesActivities, and NIH Office of Director Senior Staff to on craniofacial pain and dysfunction. Additional programsfacilitate policy development and key decisions related to include reducing pre-term and low birth weight in minorityRoadmap implementation. In addition, a team of advisors families, training in clinical research, oral health of specialwill be formed to address key aspects such as monitoring, needs and older populations, social and cultural dimensions ofcommunication, and evaluation. During this detail, Dr. health, quality of life in long-term care recipients, and the development of research-oriented curricula in dental schools.Page 5 USPHS Dental Newsletter April 2004
  5. 5. FEDERAL BUREAU OF PRISONS What do CDC dentists do? BOP Dentists Texas-bound Monica Klevens, D.D.S., M.P.H. Daniel J. Hickey, D.M.D. CDR, USPHS CDR, USPHS A foundation of the delivery of dental health care in theAlthough there are relatively few dentists at CDC Federal correctional setting involves fostering continued(~0.2% of CDC staff are dentists), many opportunities proficiency of general dentists through quality continuingexist. Most dentists at CDC have a degree in public professional education in order to better serve patients andhealth. About half of these dentists apply their training the U.S. Public Health Service. In that light, CAPT Nickand experience in dental public health, and the other half Makrides, Chief Dental Officer, Federal Bureau of Prisons,apply epidemiology to diverse scientific content areas. has been working diligently in preparing the Bureau of Prisons biannual Continuing Professional EducationIn the area of oral health, dental officers provide Dental Conference. Scheduled for the week of July 12 -technical assistance to state and local health departments 16, 2004 in San Antonio, TX, the meeting of Chief Dentalto build and maintain oral health programs Officers promises a blend of clinical issues, administrativeinfrastructure. Currently, the Division of Oral Health updates, and policy changes.provides funding for 12 states and one territory to buildcore capacity for the improvement of oral health. For those BOP dental officers who attended the lastOfficers provide the scientific support for programs to gathering in Phoenix, AZ (2002), you may recall a surveyintegrate and coordinate their oral health program was taken at the conclusion of that conference. Based on theactivities with school health programs, strengthen the needs assessment from that survey, several clinicalscientific evidence of the benefits of oral disease disciplines were identified for CDE presentation andprevention programs and support interventions in elaboration. Input was also received from the Regionalcommunities, and provide leadership in modifying oral Dental Consultants in the field. Working closely with ourhealth practice and policy by developing and distributing uniformed services partners in the Army and Navy, CAPTguidelines based on scientific research. Additional Makrides has crafted an impressive conference agenda. Dr.information about the activities of the Division of Oral Dennis Hannon, an oral and maxillofacial surgeon at WilfordHealth is available by clicking here: CDC DOH. Hall Medical Center, Lackland Air Force Base, will present on oral surgery and oral pathology. Proper diagnosis andDental officers assigned to other areas of CDC serve as management of odontogenic infections will be discussed.project officers for epidemiological studies including one Periodontist Dr. Stephen Abel will feature a lecture onthat monitors high-risk behaviors among HIV-infected identification and management of the HIV patient; cardinalindividuals and one that measures and describes drug oral manifestations of the disease, along with systemic signs,resistant invasive infections. There are dental officers laboratory testing and values, and guidelines to therapy willcoordinating HIV epidemiological studies, supporting state be highlighted. Dr. Abel’s name may ring a bell; he is one ofsurveillance activities in the National Notifiable Diseases the co-editors of “Principles of Oral Health Management forSurveillance System, and characterizing the toxicological the HIV/AIDS Patient,” a guideline manual that wasprofile of fluoride. distributed to BOP dentists. Dr. Sharon Stancliff, an M.D. and infectious disease specialist, will give a 21st centuryThere are several training opportunities at CDC for dental update on this priority area within the BOP healthcareofficers who have a masters degree in public health, system.including a 1-year residency in Dental Public Health and atraining opportunity with the Epidemic Intelligence Service, The conference will convene at a hotel (as of yeton-the-job training in applied epidemiological skills – skills undetermined; several bids are pending) on San Antonio’svital to maintenance of public health. Currently one dental famed Riverwalk in the downtown district. Within minutesofficer in that program works in HIV/AIDS surveillance. For of the Alamo, superb shopping, exquisite artistic venues, andmore information about training opportunities, click here: fine and casual dining - combined with the relaxed ambiencetraining opportunities at CDC. For questions about CDC of the Riverwalk - this meeting promises to be an exciting,experiences for dental officers, please contact CDR Ruth enlightening, and entertaining affair.Monica Klevens (click on name).
  6. 6. Page 6 USPHS Dental Newsletter April 2004 Medicaid/SCHIP dental program representatives, the American Board of Dental Public Health specialty Lights, Camera, Call to Action: examination, ASTDD and AAPHD Executive Council and business meetings. Spotlight on Oral Health All of these activities are in addition to our very full three- Jane Weintraub, D.D.S., M.P.H. day scientific program, exhibitor booths, AAPHD and ASTDD award and recognition luncheons, late-breaking hot AAPHD President-Elect picks session, networking opportunities and AAPHD town hall business meeting where our organization’s strategicComing attractions: Excitement is building around the planning, proposed resolutions and culmination of year-upcoming National Oral Health Conference to be held May long committee work will be presented, discussed, and3-5, 2004 at the Los Angeles Airport Marriott Hotel. We acted upon.received a record breaking 90 abstracts for our contributedsessions and additional abstracts for the student award We encourage everyone to register for the meeting at aaphd.orgcompetition. Online registration and conference and make your hotel reservations early. Camera-shy or not,information is available on the American Association of come join the action and share the spotlight!Public Health Dentistry website, http://www.aaphd.org.The following features are new to the conference this year: Destination: Anaheim 2004 Annual Meeting• Meeting dedication to Herschel Horowitz, and the “Herschel Horowitz Memorial Symposium: Recent R. Doug Shepherd, D.D.S advances in the Fluoride Legacy. “ CDR, USPHS• Topics not previously featured including health literacy, AGD PHS President genomics, role of physicians in improving children’s oral health, and sessions that spotlight oral health needs Now is the time to make arrangements for the 2004 Annual of children with special needs, dental care utilization Academy of General Dentistry meeting. The meeting is slated for Hispanic populations, and legal scope of practice for for July 8-11, 2004 in Anaheim, CA at the Anaheim dental hygienists. Convention Center. The Anaheim Convention Center and• An opening American Board of Dental Public Health hotels are within minutes of Disneyland and Downtown Disney. plenary session featuring speakers from the American Also, nearby sporting events, beaches, and a vast amount of Dental Association, the Henry Schein Company, and various dining and shopping spots makes a great and fun the Public Health Director from New Hampshire, all environment for you and your family. With your registration addressing the national Call to Action. fee you get a choice of 30 hands-on courses and several lectures• A celebrity speaker, Rob Reiner, for our closing and capsule clinics. Also if you come early, you can kickoff the session. meeting by playing in the 4th Annual AGD Golf Outing at the• An AAPHD foundation fundraiser evening dessert and Tustin Golf Club. For more information on this meeting, entertainment event featuring “Cher” (impersonator). including registration information, visit the AGD web page.• A Tuesday evening social event at the Redondo Beach Hope to see you there! Seaside Lagoon.• Three contributed sessions in poster-discussion format.  Membership Drive• Posters in the general poster session organized by topic.• Continuing Education credit for participation at poster This year, the PHS Constituency of the Academy of General and roundtable sessions. Dentistry is sponsoring a membership drive for new members.• Optional Sunday site-seeing tours of Los Angeles or the Heres how it works. If you are a current member of the AGD, Getty Museum. and you recruit a new member, your name will be entered into a raffle. For each new member you recruit, you will be enteredPre-conference sessions include special programs for the into the raffle (so, if you recruit 3 new members, your nameAmerican Association for Community Dental Programs, will be in the raffle 3 times).
  7. 7. ▼ Continued on the next pagePage 7 USPHS Dental Newsletter April 2004 House of Delegates. One is the Chief Dental Officer of the AGD Article – continued from previous page USPHS. The other is elected by all USPHS dentists, including PHS officers and civil service dentists within theThe Grand Prize for the raffle will be a 50% deduction in Department of Health and Human Services.your 2005 AGD dues, a $125-145 value depending on yourcurrent membership dues. The PHS Constituency will Every two years an election is held to select an ADA-memberdirectly pay this amount toward your 2005 AGD dues. The USPHS dentist who will serve a four-year term. During theraffle will be held at the AGD annual meeting in Anaheim. first two years the dentist serves as an alternate delegate to theThere may be additional raffle items as well. elected voting delegate and substitutes for the elected voting delegate as needed. During the next two years, the dentist is aTo be eligible for this raffle, membership applications can voting delegate to the ADA House of Delegates.be obtained through any AGD member or through myself,CDR Doug Shepherd {W- (812) 238-1531 ext 429, fax For more information, including responsibilities of the elected(812) 238-3308}, or Membership Chair, LCDR Tim delegate, qualifications, nomination procedure, electionRicks{W- (775) 574-1018 ext 224, fax (775) 574-1028 ext. procedure, and where to get more information, see the entire224}. You can also obtain an application by calling the announcement on the USPHS Dental Bulletin Board (click theAGD at 1-888-AGD-DENT or visit the AGD web page link, go to browse, type in DentalBulletinBoard, click on Aprilclick on “Join the Academy”. It should list the sponsor 2004 archives) for the USPHS ADA Delegate.name on the form (bottom of the application). The sponsoris the current AGD member that recruited the dentist to joinAGD. If you want to make sure your name is entered in the ADA Foundation Proposals for Children’s Oralraffle, you can send a copy of the membership application Health Programsto either LCDR Ricks or me. (Reprinted from web site)Interested candidates can join the Academy without having The ADA Foundation, the charitable arm of thea sponsor. Also, candidates from other dental specialties American Dental Association, has established acan join. Again, to be eligible for the raffle prize(s), all permanent endowment fund dedicated to theyou have to do is to get another PHS dentist to join the prevention of childhood caries and oral healthAGD (and have them list you on the application), so go maintenance for children. The Harris Fund willahead and talk to your colleagues today. award competitive grants to applicants whose oral health promotion programs are designed to improveSpread the word about the opportunities and rewards that and maintain childrens oral health throughyou get with the AGD! community education programs. The grant programs main objective is to help children whose socioeconomic status impacts their Call for Nominations: access to professional oral care and adversely Elected USPHS Delegate affects their oral health habits at home. Carolyn A. Tylenda, D.M.D., Ph.D. Proposals of up to $5,000 for community-based, Chairperson, Selection Committee non-profit, oral health promotion programs in the United States and its territories will be considered.The Public Health Service (PHS) Delegate Selection Committee Examples of qualified oral health promotionsfor the American Dental Association (ADA) House of include: dental health education conducted atDelegates is accepting nominations for the position of elected schools, health fairs, and social agencies, viadelegate to the ADA House of Delegates for the term July 2004 mobile dental clinics or outreach programs; dentalto June 2007. This is a unique opportunity to represent U.S. health education programs held in conjunction withPublic Health Service dentists, to gain insight into the preventive programs such as fluoride and dentaldeliberations of organized dentistry, and to have impact on sealant application programs; oral healthissues in public health dentistry. and nutrition education materials designed for parents and/or dental professionals; instruction inBackground: The USPHS is authorized by the ADA to have the proper use of oral care products; developmenttwo voting delegates to the American Dental Association of public service announcements (PSAs) to increase
  8. 8. awareness and appreciation for effective proper childhood oral care. Click on this RFP link for more info:Page 8 USPHS Dental Newsletter April 2004 Junior Officer Spotlight: his parents, grandparents, cousins, and elders who first taught him the importance of courage and faith, as well as LCDR Phillip Woods the value of hard work and living a life devoted to service. In his paintings, he has attempts to capture Wilnetta Sweeting, D.D.S. everyday people in such familiar settings as at work and CDR, USPHS Church. Should you ever be given an opportunity to view his work, you may be reminded of an aunt, someone fromThe son of a Baptist preacher and one of six children, Church or perhaps an event from childhood past.LCDR Phillip Woods was born and raised in Burlington,North Carolina. He attended primary school in Burlington Though LCDR Woods has only been in the USPHS forand upon graduating from High School in 1976, attended approximately a year, his professionalism, commitment, andthe University of North Carolina at Chapel Hill where he energy as a dental officer are already evident. His is a brightreceived an AB in chemistry and a DDS degree in future with the PHS. Should you get a chance to view hisdentistry. LCDR Woods then pursued a periodontal paintings in the future, his talent as an artist will be evident ascertificate from Tufts Dental School and most recently, a well.master’s degree in public health from Harvard Universityin 2002. Senior Officer Spotlight:LCDR Woods joined the United States Public Health CAPT Frank MendozaServices in March 2003. He is Staff Dental Specialist atFCI Phoenix, Arizona and serves as the only PHSperiodontist for the Federal Bureau of Prisons. Involved Robin Scheper, D.D.S.in numerous professional affiliations, he has received LCDR, USPHSvarious awards and honors. One may remember LCDRWoods from his Category Day presentation at the USPHS CAPT Frank Mendoza began his career with the USPHS inCOA 2003 annual conference in Scottsdale, Arizona 1982 as a National Health Service Corps Scholarshipwhere he delivered an abstract entitled "The Impact of recipient. His first assignment was on the NavajoDental School Admissions on Workforce Development". Reservation, at the Chinle Service Unit in Arizona. CAPT Mendoza practiced both at the Lukachukai and Chinle clinicsIn 1997, LCDR Woods began a series of paintings based during his two-year tour of duty. He then transferred to theon family photos. Soon he ran out of photos he felt Cherokee Service Unit in North Carolina, where he spent fivecaptured his African American Southern rural roots. In years as a staff dentist. His next assignment was as ChiefSeptember 2000, while searching through online Library Dental Officer of the Winslow Service Unit Dental Programof Congress WPA prints and photographs (circa 1939), back in Arizona. CAPT Mendoza then took advantage of aLCDR Woods was both shocked and thrilled to find long-term training opportunity in Pediatric Dentistry. Heseveral “youthful” photos of his now deceased received his Certificate in Pediatric Dentistry from thegrandparents, as well as other elderly cousins, family and University of Minnesota College of Dentistry in 1993. Afterfriends. Specific names were not listed but Woods’ completing his residency, he returned to the Chinle Serviceparents, and other relatives helped him confirm their Unit and served as the Navajo Area Regional Pediatric Dentalidentities. The familiar settings and subjects of these Consultant until 1998. He then transferred to the Portlandphotographs touched him on many levels. Thus his Area, specifically to the Warm Springs Service Unit, in Warmproject then began, a project which would become an Springs, Oregon, where he currently serves as theartistic, spiritual and emotional as well as a genealogical Area/Regional Clinical Specialty Consultant.journey. Nearly four years from it’s inception, his workhas culminated with his first solo show of oil paintings As the Area/Regional Clinical Specialty Consultant for theentitled, "My People". Through his art, he gives tribute to Portland Area Indian Health Service, CAPT Mendoza is
  9. 9. responsible for area, state, and national dental staff training inpediatric and interceptive dental procedures. ▼ Continued on the next pagePage 9 USPHS Dental Newsletter April 2004Senior Officer Spotlight – continued initiates their clinical trail this year. It is anticipated thatHe is also responsible for treatment and consultation of the trial will go until 2006.pediatric dental referrals from dental and non-dentalhealth care providers from the area and state of Oregon. In the past 20 years that CAPT Mendoza has served in theHe also serves as a consultant for pediatric dental USPHS, he noted that the I.H.S. has become much lesspreventive dental procedures and techniques. CAPT centralized. With this decentralization has come the lossMendoza is a member of both the Indian Health Service of the opportunity for close interaction with fellow dentalEarly Childhood Caries Prevention Committee and the colleagues that existed in the early 1980’s. He stated thatOregon Early Childhood Caries Prevention Coalition. the addition of dental hygienist providers into many theWhat is unique about the pediatric dental program at I.H.S. areas began during this period. He also noted thatWarm Springs Health and Wellness Center is that the the option to hire Civil Service dentists has increased thefacility is an ambulatory clinic, and not a hospital, which Indian Health Service’s ability to hire more dentists.has an operating room to treat young children withsignificant dental disease. Prior to his tenure at Warm Regarding the future of the category, relative to I.H.S.,Springs CAPT Mendoza coordinated with a hospital in CAPT Mendoza believes that the need to treat NativeBend, Oregon, to be able to treat the patients in an Americans will never go away. Even though he has justoperating room setting. He didn’t let the fact that OR begun his 22nd year of active duty, he has no plans onfacilities weren’t immediately available prevent him retiring any time soon. He thoroughly enjoys theresearching the options of being be able to provide non- experiences he has had with the Indian Health Servicetraumatic full mouth dental rehabilitative care to the over the years. He can think of no other job that offersyoung children of the Confederated Tribes of Warm such diversity, opportunity, and fulfillment, not evenSprings in a extramural setting. private practice.During his tour of duty at Warm Springs, CAPT Mendozabecame involved in a Food and Drug Administrationclinical trial, which began in February of 2003. Theclinical trial is studying the effects of chlorhexidinevarnish on the reduction of Streptococcus mutans. Thepurpose of the study is to determine if chlorhexidinereduces the level of Streptococcus mutans in mothers, How do I become part of the PHS Ensemble ifthereby preventing the transmission of the caries causing I don’t live in the D.C. Area?bacteria to the child when the child’s teeth are firsterupting. The clinical trial is will evaluate 600 pairs of Suzanne K. Saville, D.D.S.mothers and their children. First, the mothers have to be CDR, USPHScaries free, and her child must be at least five months ofage. The chlorhexidine varnish is applied in two stages. CAPT John Bartko (Ret) answered this question for me. IThe first stage entails coating the mother’s teeth with an began a search for the PHS march when our local communityactive chlorhexidine layer, and the second stage is a thin band director stated that he would like to play all of thesealant coating on the mother’s teeth. The coating allows marches of the military branches. Through electronic mailthe chlorhexidine to be more effective than a rinse or a forwarded several times I was directed to CAPT John Bartkogel because it keeps the active ingredient in contact with (Ret). He was able to send me an electronic version of thethe tooth for a longer period of time. Evaluation of the PHS march and he told me how I could participate as a fieldeffectiveness of the chlorhexidine varnish in this double ensemble member by forming a group and playing for anblind placebo controlled study involves CAPT Mendoza, official function. Finding the group was easy; members of theand the other staff working on the study, evaluating caries community band volunteered to play. The official functionprogression in the mother and child every six months was a retirement ceremony for a USPHS Coast Guard dentist.until the child reaches age two. In February 2003 Warm We played the PHS march, National Anthem and SemperSprings was the first I.H.S. site to actively treat mothers Paratus. Many compliments were made about the band’sin this study. The Yakama Service Unit began their performance and there is talk of our group playing for aclinical trial last summer, and Tuba City Service Unit change of command ceremony in the distant future. The retiree felt honored by the band’s performance and thought it
  10. 10. brought the retirement ceremony to a new level. If you would CDR Randall Mayberry or CAPT John Bartko (Ret) forlike more information about the ensemble, please contact information.Page 10 USPHS Dental Newsletter April 2004 Selection and Use of Antibiotics Streptococcus likely to be sensitive.2 Understanding the microbial nature of an oral infection is an important basis for the empiric selection of antibiotics. Jerry Holbrook, D.D.S. Oral & Maxillofacial Surgery Consultant The other important factors in antibiotic selection besides organism sensitivity are:So, you have decided your patient needs antibiotics. This 1. Utilizing narrow spectrum antibiotics 2. Bactericidaldecision was based on the patient’s clinical presentation; antibiotic 3. Toxicity of antibiotic 4. Antibiotic cost 5.you know, color, dolor, tumor, rubor, and functio laseo! Patient history of allergies, sensitivities and drugThe cardinal signs of inflammation. The patient also has interactions 6. Patient compliance 7. Host defensethe signs of systemic involvement; fever, malaise, mechanisms 8. Severity or magnitude of the infection.elevated white blood cell count, and a toxic sick Each plays an important role in our choice of drug for anappearance. Two major decisions go into selecting an odontogenic infection. Oral infections have a longantibiotic, which one to use and how long to use it. Now, history of effective treatment with penicillin, which inwhich antibiotic are you going to select? Penicillin is turn is still one of the best fits of the listed criteria.always a good choice, but is it the right choice? Here is abetter question; why is penicillin a good choice? Do you Now let’s discuss the duration of antibiotic therapy. If weknow? What kind of information did you use to select place the patient on antibiotics for seven days and neverpenicillin? How long should you keep your patient on check the patient for signs of recovery, we have made antheir antibiotics? Did you answer: seven days? Why empiric decision about the duration of antibioticseven days? Is the answer always seven days? Will the treatment. We cannot make empiric decisions aboutquestions in this introduction ever stop? duration for antibiotic therapy. There is no scientific evidence that odontogenic infections last seven days (orLet’s begin by evaluating how we select an antibiotic. As ten days). If we re-evaluate our patient after seven days ofclinicians we typically make an empiric choice (practice antibiotics and find that the signs and symptoms ofbased solely on experience) to select the antibiotic we use infection have abated for at least three days, we can thenfor our patients. If an empiric decision for an antibiotic is make a clinical decision to stop antibiotics. The durationmade, it is known as initial antibiotic therapy. If the of antibiotic therapy should be 3 days after the signs andorganism(s) is clearly identified by culture and antibiotic symptoms of infection have abated. You must continuesensitivity testing results are known, definitive therapy to follow your patient during antibiotic therapy to assesscan be initiated and we have made a scientific antibiotic the effectiveness of your prescribed treatment. Your firstchoice. We can make an empiric choice of an antibiotic follow-up exam should be in 48 hours to assess thein dentistry because the microbiologic patterns of impact your dental treatment and the antibiotics have hadodontogenic infections have been clearly defined in the on the patient’s symptoms. You can then continue yourdental literature.1 prescribed treatment, change or add antibiotics if indicated, or perform additional surgical treatment ifThe most common mild to moderate odontogenic indicated.infection is composed of a mixed flora of aerobic andanaerobic organisms. In early cellulitis type infections Let us review the main antimicrobial classes utilized inaerobic organisms predominate. In well-circumscribed dentistry. This will not include the dosing andabscess type infections anaerobic organisms predominate. pharmacology since this information is readily accessedThe most common aerobe organisms are the in the many texts and pharmacology resources. Instead IStreptococcus Viridans type, which are usually sensitive will try to give you some practical information as toto penicillins and similar antimicrobials. The most which antibiotic to prescribe in clinical situations and thecommon anaerobic organisms are Prevotella Spp., side effects to be aware of with each antibiotic. There areFusobacterium Spp., and Streptococcus Spp. These 7 antimicrobial classes to consider: 1. Penicillins &anaerobes have varying sensitivities to the penicillins Cephalosporins. 2. Metronidazole 3. Clindamycin 4.with Prevotella likely to be resistant and Fusobacterium & Sulfonamides 5. Macrolides 6. Quinolones 7.
  11. 11. Tetracyclines. Only the first three should be used on anempiric basis. It is unusual to use any other antibiotics on ▼ Continued on the next pagean outpatient basis or without appropriate laboratorystudies.Page 11 USPHS Dental Newsletter April 2004 symptoms after 48 hours. Flagyl works well for patient Penicillins & Cephalosporins compliance because you can use it on the same dosingThe beta-lactams are bacteriocidal and are the dental schedule as penicillin. The cost is double the cost ofworkhorse in mild to moderate dental infections. Some penicillin. Common side effects include GI upset and aare paired with clavulanate to neutralize the effect of betalactamase. Penicillin V is my drug of choice for minorinfections and is very effective coupled with a correct metallic–tasting glossitis. Drug-drug interactions includediagnosis and dental surgical treatment (root canal Coumadin, alcohol and phenobarbital.debridment, extraction, etc) of an infection. Penicillin Ggiven IM or IV is an excellent choice for more severe Clindamycininfections and for children who may be unable or In high doses, clindamycin is a bactericidal with excellentunwilling to take oral medicine. Penicillin G is also good aerobic and anaerobic coverage. This makes it anto use as a loading dose prior to surgical treatment for excellent choice for the polymicrobial nature of oraltissue prophylaxis. Amoxicillin is an alternative to infections.4 I use clindamycin for moderate to severepenicillin, essentially providing the same microbial infections. With the increasing resistance of bacteriacoverage as penicillin, but at a higher cost. The GI tract found with the penicillins, clindamycin is becoming abetter absorbs it, but as a broad spectrum antimicrobial valuable chemotherapeutic agent for my severemay have more side effects during treatment. odontogenic infections. Some texts now state this is theAmoxicillin is known to cause skin eruptions and first line drug of choice for oro-facial infections. It ispsuedomembranous colitis as side effects. When paired important that we try to reserve this drug for our majorwith clavulanate it has improved microbial spectrum infections or infections that have a definitive culture andcoverage for beta lactamase producing organisms. sensitivity. In addition, this antimicrobial has very goodClavulnate increases the cost of therapy about ten-fold. bone penetration which makes it my initial drug of choiceOther penicillinase resistant antibiotics include for an osteomyelitis. It has replaced erythromycin as thecloxacillin, nafcillin, and dicloxacillin. These can also be second drug of choice for endocarditis prophylaxis.used when a beta lactamase producing organism such as Clindamycin, like most broad-spectrum antibiotics, canstaph aureus is suspected. The extended spectrum cause drug-induced colitis. Clindamycin is triple the costpenicillins such as ticarcillin, mezlocillin, and piperacillin of penicillin.have limited usefulness in most oral infections. Tenpercent of patients will have some type of sensitivity or The selection and use of antibiotics is part of the art ofallergy to this class of medications. Of this ten percent – and science of treating infections. Antibiotics are never aten percent will have cross reactivity between penicillins stand-alone treatment for infections. Infections must beand cephalosporins. The first generation cephlasporins treated with an appropriate surgical intervention to allowalso have similar microbial coverage as penicillin. They the patient’s host defense mechanisms the besthave a significantly broader spectrum and similar side opportunity to overcome the microbial invasion.effects as the penicillins. Depending on the generation, Treatment should be initiated as soon as possible to allowcosts are two to ten times that of penicillin. the host and the antibiotic the best chance to be effective.Cephalosporins have better coverage of staph aureus and I It is important to educate your patient about dose, timing,will use a first generation cephalosporin like Keflex for and duration of therapy. Keep your patient motivated andmy trauma patients with skin lacerations. informed about the care you are providing. Vigilance and timely intervention help to prevent treatment failures and Metronidazole determine if a patient requires a higher level of care. WeOk, so Flagyl and Clindamycin are not a class, but they are fortunate that most odontogenic infections respond toare very valuable antibiotics. Metronidazole is dental treatment and the use of antibiotic therapy.bactericidal and has very good anaerobic coverage.Ninety percent of obligate anaerobes are sensitive to this 1. Peterson LJ: Microbiology of head and neck infections, Oral Maxillofac Surg Clin North Amantibiotic,3 but is not used as a single agent in oral and 3:255, 1991.facial infections since it will not cover aerobic organisms. 2. Topazian RG, Goldberg MH, Hupp JR: Oral andIt is a great adjunct when used with penicillin in Maxillofacial Infections, Philadelphia, 4th Ed. 2002,odontogenic infections. I will add it to a patient’s W.B.Saunders.antibiotic therapy when there is no improvement in
  12. 12. 3. Goldberg M: Antibiotics-Old Friends and New Acquaintances, Oral Maxillofac Surg Clin North Am 13:15, Feb 2001.4. Flynn TR, Halpern LR: Antibiotic Selection in Head and Neck Infections, Oral Maxillofac Surg Clin North Am, 15:19, Feb 2003.Page 12 USPHS Dental Newsletter April 2004 bacteremia originating from a number of different Antibiotic Prophylaxis for Patients with anatomical sites. Additionally artificial joint infection Artificial Joints may be the result of bacteria introduced during the arthroplasty procedure. Bacterial contamination at the time of surgery is thought to be the predominate cause for Stephen P. Torna, D.D.S. these infections.4 The dental community is concerned Clinical Perspectives Editor with the possibility of a hematogenous route to infection.Artificial joint failure is associated with crippling Joint infections are classified as early and late. Mostmorbidity and mortality. Infected joints may require authors agree that an early infection occurs up to 3 to 6extensive revision and result in permanent deformity, months following arthroplasty. Early infections accountshortening of limbs, and death. “The devastating for as many as 50% of joint infection cases. The origin ofmorbidity and unusually high rate of mortality (18%) the early infection is most often considered to be woundassociated with infected prosthetic joints would seem to contamination during the procedure and the bacterialfar overshadow the risks and academically debatable culprits are predominately Staphylococcal organisms.benefits of antibiotic prophylaxis.” 1 The seriousness ofpotential sequelae requires a thoughtful approach to the Evidence for hematogenous joint infection of dentalmanagement of artificial joint patients. origin has been reported.1,2,12The literature shows that streptococcus and other common oral bacteria have beenThe American Dental Association (ADA) and the isolated from infected joints. In some cases an invasiveAmerican Academy of Orthopedic Surgeons (AAOS) dental procedure was documented just prior to the jointrecognize the potential for hematogenous spread of infection. These cases suggest a dental oral origin for theinfection from the oral cavity to an artificial joint. The infection.ADA and AAOS have developed recommendations andguidelines for antibiotic prophylaxis prior to providing Bartzokas et al reported four late total joint infections ininvasive dental treatment for the arthroplasty patient.3 males ages 58-83 in which the common oral microbeAll patients within their first two years of joint Streptococcus sanguis was isolated from the infectedreplacement, immune compromised patients, and those joints. All four men were diagnosed with advancedwith type 1 diabetes are among the highest risk for joint periodontal disease. Although it cannot be proven thatinfection. Cephalexin and clindimycin have been these streptococcal joint infections were a result ofidentified as the preferred prophylactic antibiotics. hematogenous spread originating from the oral cavity, the circumstantial evidence is compelling. Any otherEvidence for a dental origin of metastatic artificial joint possible route or cause for these infections is unlikely.infection is largely circumstantial. The literature indicates Interestingly, these infections were not the theoreticalthat joint infections following arthroplasty may originate result of invasive dental treatment but rather the result offrom distant sites and many cases have convincing poor hygiene and dental neglect. The inference is that aevidence that hematogenous joint infection has occurred chronic bacteremia from untreated disease and not a(identical bacterial isolates from infected joint and distant treatment induced transient bacteremia was the source ofinfection). Urinary, gastrointestinal and upper respiratory the joint infection. 18tracts, dental, and skin infections are among thoseimplicated in causing some artificial joint Jacobsen and Murray reviewed 1855 hip replacementinfections.1,2,8,9,15 patients in which thirty-three patients (1.7%) developed infections. Bacterial isolates from each of the thirty-threeThere are two theories for the pathogenesis of artificial infected hips included fifteen Staphylococcus aureus, sixjoint infection. Metastatic or hematogenous spread of Staphylococcus epidermidis, six Psuedomonas auriginosa,infection may result from a chronic or transient four Streptococci, two Enterobacteria, one Peptostreptococcus, and one Candida tropicalis. One of1 43 11 1
  13. 13. these cases was considered to be suspicious of dentalorigin and the authors concluded that a correlationbetween dental treatment and the infected joint could notbe positively demonstrated.7Rubin reported three cases of joint infection proximate todental treatment that he describes as having a worrisomerelation with the total hip replacement (THR) failures. Inthe first case, a 68 year-old female 5-½ years post THR7
  14. 14. Page 13 USPHS Dental Newsletter April 2004 remaining 31% yielded Beta Steptococci, Enterobacteriareceived several months of dental care including cloacae, Peptosterptococcus, Streptococcus faecalis,restorative, endodontic, and periodontal treatment. The Proteus mirabilis, Esherechia coli, Klebsiella pneumonia,dentist and orthopedic surgeon agreed that antibiotic Diptheroids, Streptococcus viridans and Lactobacillus.15prophylaxis was not necessary. Four weeks followingdental care, the patient was diagnosed with an infected In a 1998 study Berbari et al retrospectively examinedjoint. Proteus mirabilis was cultured from the hip and the 468 total joint infection cases that occurred out of 26,505joint was removed. In the second case a 58-year-old arthroplasty procedures performed at a Minnesotafemale underwent periodontal surgery 17 days post THR. institution. Many post arthroplasty risk factors forThe patient was given prophylactic antibiotics. Dental infection were identified in this study. The major riskabscesses were cultured and grew Steptococcus and factors include rheumatoid arthritis, steroid therapy,Neisseria. Five years later, the patient required tooth malignancy, diabetes, malnutrition, prior arthroplasty, andextraction and 3 weeks post extraction her hip prosthesis prior joint infection. Staphylococcal organisms werewas removed. The bacterial isolate from the hip was identified in more then 50% of the infections andStaphylococcus aureus. Although present in small Streptococci, gram-negative bacilli, and variousnumbers in the oral cavity, it is possible that dental care anaerobes were also isolated.16 The authors stress riskwas the cause. It is also plausible that this late joint assessment and risk management in preventing total jointinfection resulted from a latent bacterial contamination infections.introduced at the time of the initial orthopedic surgery.The third case involved a 62-year-old male THR patient A 2003 joint statement by the ADA in conjunction withthat developed a joint infection 2 years after arthroplasty the American Academy of Orthopedic Surgeons (AAOS)and 8 months following root canal therapy for an has identified arthroplasty patients that may be atabscessed tooth. The dental abscess was not cultured but increased risk for hematogenous joint infections.the infected hip yielded beta-hemolytic streptococci. The According to this statement all patients within 2 yearsprosthesis was removed.2 Each patient survived the post arthroplasty require antibiotic prophylaxis prior toinfection with a significantly impaired ability to ambulate. invasive dental treatment. Immune compromise,One of the patients became septic and experienced a long malnutrition, type 1 diabetes, blood dyscrasias, cancerand complicated hospitalization. and a history of previous joint infection are among conditions that may increase the risk for metastatic jointAhlberg et al conducted a retrospective study of 7 THR infection following dental treatment.3 The suggestedinfection cases that were considered to be the result of antibiotic prophylaxis regimen is Cephalexin (keflex) 2hematogenous spread. An infected rheumatoid nodule on grams 1hour prior to dental treatment for those notan elbow, gangrene of the hand, an infected toe and an allergic to penicillin. For patients allergic to penicillin,infected finger wound were among distant Staphylococcal the recommendation is clindimycin 600 mg 1 hour priorinfections that were attributed as the cause of the joint to dental care.3 Cephalexin is acid stable, quicklyinfection. Cases of Salmonella and beta-hemolytic absorbed, has a high degree of bone penetration, and it isStreptococci cultured from infected joints with effective against penicillinase producing Staphylococcigastrointestinal and unknown primary foci respectively (aureus and epidermidis). Beta-hemolytic Streptococci,were also mentioned. This study cited additional cases Proteus mirabilis, Neisseria and other bacteria implicatedthat identified pneumonia, urinary tract infection, dental in joint infection are susceptible to Cephalexin.1,6 Thisabscess, kidney infection and parototitis as likely foci of advisory statement also specifies that dental extractions,the primary infection.9 periodontal procedures, implantology, endodontics, orthodontic band placement, and intraligamentaryIn another retrospective study, Jacobsen and Millard, anesthesia have the greatest incidence of causing alooked at 2693 total joint replacement patients and found transient bacteremia.that thirty (1.7%) of these joints became infected. Of thethirty late infections, seven occurred in patients with type In summary, artificial joint infection may result in1 diabetes mellitus and two people were immune devastating and disabling morbidity with a mortality thatsuppressed. Eight of the thirty had a history of early may reach as high as 18%. Studies have shown that moreinfection and five patients had proximate urinary tract than 50 % of early and late joint infections result frominfections. Staphylococcus aureus and epidermidis wereisolated in 54% of these cases while 15% of joint 1aspirates cultured Psuedomonas auriginosa. The 1 32 39 1
  15. 15. Page 14 USPHS Dental Newsletter April 2004 deep infections after total hip replacement. ClinStaphylococcus epidermis and Staphyloccocus Orthop 1978;137:69-75.aureus. The remaining cases are caused by alpha andbeta Streptococci, Pneumococcus, Peptostreptococci,Proteous, Escherichia, Proprionibacterium and otherorganisms. 1,2,8,9 Among the non-Staphylococcal 10. Jacobsen JJ, Millard HD, Plieza R, Blankenshipinfections, Streptococci are the most commonly JR. Dental treatment and late prosthetic jointisolated microbes. Reasons for joint replacement infections. Oral Surg Oral Med Oral Patholinclude rheumatoid arthritis, osteoarthritis, 1986;61:413-7.degenerative joint disease, hip dysplasia, and trauma. 11.Thyne GM, Ferguson JW. Antibiotic prophylaxisThe literature identifies rheumatoid arthritis, type 1 during dental treatment in patients with prostheticdiabetes mellitus, malignancy, history of artificial joints. J Bone Joint Surg Br 1991;73-B:191-4.joint dislocation, and immune compromise as major 12.Downes EM. Late infection after total hiprisk factors for the development of these infections. replacement. J Bone Joint Surg Br 1977;59-B:42-4.It is possible that metastatically spread late prosthetic 13.Council on Dental Therapeutics. Management ofjoint infections of dental origin have occurred. dental patients with prosthetic joints. JADAInvasive dental procedures that cause a transient 190;121:537-8.bacteremia as well as chronic bacteremia resulting 14.Ince A, Tiemer B, Gille J, Boos C, Russlies M.from untreated dental disease have been implicated as Total knee arthroplasty infection due to Abiotrophiaa primary source for hematogenous joint infection. defectiva. J Med Microbiol 2002;51:899-902. 15. Jacobsen JJ, Millard HD, Plieza R, Blankenship References JR. Dental treatment and late prosthetic joint infections. Oral Surg Oral Med Oral Pathol1. Cioffe GA, Terezhalmy GT, Taybos GM. Total 1986;61:413-7. joint replacement: consideration for antimicrobial 16.Berbari EF, Hanssen AD, Duffy MC, Ilstrup DM, prophylaxis. Oral Surg Oral Med Oral Pathol Harmsen WS, Osmon DR. Risk factors for 1988:66:124-9. prosthetic joint infection: case-control study. Clin2. Rubin R, Salvati EA, Lewis R. Infected total hip Infect Dis 1998;27:1247-54. replacement after dental procedures. Oral Surg 17.Jacobsen JJ, Patel B, Asher G, Wooliscroft JO, Oral Med Oral Pathol 1986;41:18-23. Schaberg D. Oral Staphylococcus in elderly3. Advisory Statement American Dental Association subjects with rheumatic arthritis. J Am Geriatr Soc and American Academy of Orthopedic Surgeons 1997;45:1-5. Advisory Statement. Antibiotic prophylaxis for 18. Bartzokas CA, Johnson R, Jane M, Martin MV, dental patients with total joint replacement. Pearce PK, Saw Y. Relation between mouth and JADA 2003;134:895-99. hemaetogenous infection in total joint replacement. Br4. Little JW. The need for antibiotic coverage for Med J 1994;309:506-8. dental treatment of patients with joint replacements. Oral Surg Oral Med Oral Pathol 1983;55:20-3.5. Advisory Statement American Dental Association and American Academy of Orthopedic Surgeons. How do you like the new JADA 1997;128:1004-08. USPHS Dental Newsletter?6. Little JW. Managing dental patients with joint prosthesis. JADA;125:1374-78.7. Jacobsen PL, Murray W. Prophylactic coverage Do you have suggestions for further of dental patients with artificial joints: A improving this newsletter? retrospective analysis of thirty-three infections in hip prosthesis. Oral Surg Oral Med Oral Pathol 1980;50:130-3. If so, contact the editor.8. AndrewsHJ, Arden GP, Hart GM, Owen JW. Deep infection after total hip replacement. J Bone Joint Surg Br 1981 Feb;63-B(1):53-7.9. Ahlberg A, Carlsson AS, Lindberg L. Did you like a particular article – did you find Prophylactic antibiotics against early and late it had useful information, or was interesting? If so, we encourage you to click on the1 author’s name and let him/her know that his/
  16. 16. her contribution to the newsletter is appreciated.Page 15 USPHS Dental Newsletter April 2004Pictures courtesy of LCDR Aaron Means, CDR DavidCrain, LCDR Scott Trapp, and CDR Randall Mayberry.Thanks to all of those USPHSDental Officers that have servedon these recent deployments!