Keep Those Teeth Clean or else...

Several years ago I saw a patient in the hospital for bacterial endocarditis. Bacterial endocarditis is an infection of the heart lining or valves. It is a very serious condition requiring intravenous antibiotics for at least one month. The patient was a young male with a relatively unremarkable medical history. Upon examination, he was found to have multiple dental cavities with gingivitis. Poor dentition is a cause for infective endocarditis! Then, several months ago, I was involved in a young female who was admitted due to strokes from endocarditis. After an extensive evaluation, it was presumed that the infection was from her oral cavity.

Infective or bacterial endocarditis affects about 29,000 individuals yearly. Individuals with heart conditions such as prosthetic valves, history of rheumatic carditis, congenital disease, or Marfans syndrome are at risk. The source of infection may come from IV drug use, dental procedures, GI procedures, urinary and prostatic procedures, skin infections, colon cancer, cardiac surgery, or respiratory infections. The bacteria enters the bloodstream and settles onto the heart. A vegetation or infective mass develops on the valve resulting in a cascade of signs and symptoms such as fever, rash, joint pain, fatigue, cough, weight loss, skin lesions, trouble breathing, etc...

One important preventative task is to keep those teeth clean. Routine brushing, flossing, and dental visits will keep the bacteria from developing and seeding into the body.

Antibiotics during dental procedures may be used to prevent endocarditis in high risk individuals. A single dose of Amoxicillin or Clindamycin is typically given one hour prior to the procedure. Guidelines suggest antibiotic prophylaxis in treatments involving gingival or tooth root manipulation.

The following conditions should receive antibiotics:
1. People with artificial heart valves
2. Certain congenital heart disease conditions
3. Previous history of endocarditis
4. Cardiac transplant

Mitral valve prolapse is not an indication for antibiotics.

Practice good oral hygiene and keep brushing those teeth!
For more information, talk to your health care professional and dentist. Thanks!

Male Breast Cancer

A pleasant 60 year old obese male presented to my office with complaints of a left breast lump for the past several months. He described it as tender and firm. There was no redness or pus. It was near his nipple area. He has no family history of breast cancer. His medical history was unremarkable. He does have a 30 year history of tobacco use. Upon examination, a 2 cm mass was palpated and minimally tender. He was sent for a diagnostic mammogram and ultrasound. The results came back highly suspicious for tumor and he was promptly referred to surgery for biopsy. His results are pending.

Male breast cancer is rare. About 1% of breast cancers occur in men. About 2000 men were diagnosed with breast cancer in 2008 with approximately 400 deaths. Typically, male breast cancer occurs between the ages of 60 and 70 with the median age being 67.

Risk factors include:
1. Age
2. Obesity
3. Heavy alcohol use
4. Liver disease
5. Hormone usage
6. Klinefelter Syndrome (chromosomal disorder)
7. Strong family history of breast cancer
8. Radiation exposure
9. High estrogen levels (from obesity, alcohol, hormone use, etc...)

Signs and symptoms include:
1. Lump
2. Nipple pain
3. Nipple discharge
4. Enlarged lymph nodes under the armpit
5. Changes to the breast skin such as redness, dimples, scaling...
6. Nipple soreness
7. Nipple inversion

Diagnosis is made by mammogram, ultrasound, and biopsy.
The most common type of male breast cancer is infiltrating ductal carcinoma.

Treatment depends on the staging/severity. It may consist of mastectomy, chemotherapy, radiation, and/or hormone therapy.

Male breast cancer is very similar to female breast cancer. Prognosis and remission rates are virtually identical and is based on the staging and extent of the cancer.

Two ways to prevent this rare disease is to maintain a healthy weight and to drink alcohol in moderation.

Talk to your health care professional for more information.

Thank you and have a nice day.