ROCHESTER, Minn. — In the first study examining dental records in the Rochester Epidemiology Project, results show that dentists and oral surgeons are in good compliance with guidelines issued by the American Heart Association (AHA) in 2007, describing prophylactic antibiotic use prior to invasive dental procedures.

The Rochester Epidemiology Project is a collaboration of medical and dental care providers in Minnesota and Wisconsin. With patient agreement, the organizations link medical, dental, surgical procedures, prescriptions, and other health care data for medical research.

Prior to 2007, the AHA guidelines recommended prophylactic antibiotics for patients with cardiac conditions who were at moderate or high risk of developing infective endocarditis—a potentially deadly infection of the heart valve. After 2007, AHA recommended that only high-risk patients receive the antibiotics. This group represents a very small fraction of the individuals receiving antibiotics before 2007, says Daniel DeSimone, M.D., study lead author and infectious diseases and hospital internal medicine physician at Mayo Clinic. The study will be released May 23 online in Mayo Clinic Proceedings.

Earlier studies by Dr. DeSimone’s team determined the incidence of infective endocarditis in Olmsted County before and after 2007, using Rochester Epidemiology Project data. They found no significant increase in cases of infective endocarditis following the introduction of updated AHA guidelines.

However, “the major limitation of these studies was the lack of access to dental records,” says Dr. DeSimone.

“The inclusion of dental records in the Rochester Epidemiology Project provides a unique opportunity unlike any population health database in the United States,” he says.

“The primary criticism of the earlier studies was, ‘Are dentists actually following the 2007 AHA guidelines, or do patients continue to receive antibiotics when no longer indicated?’” reports Dr. DeSimone. “How could we prove that dentists were actually following the guidelines, rather than assuming they were? Now we can.”

Dr. DeSimone also says, there are a number of health risks for patients when taking antibiotics. “Plus overuse of antibiotics can result in increased bacterial resistance, which is a widespread public health problem,” he says.

In addition, while the cost to patients might only be a few dollars a dose, Dr. DeSimone says that when added up, this group of moderate-risk patients could spend well over $100 million per year.

“Using the Rochester Epidemiology Project, we have shown that the new guidelines were very helpful in reducing unnecessary antibiotic use and related issues, without an increase in new cases of infective endocarditis.”

Although this was the first study using the newly linked dental records, it was just one of more than 2,600 medical research publications using the Rochester Epidemiology Project. Using medical and dental records, researchers can identify what causes diseases and how patients with certain diseases respond to surgery, medication or other interventions. They also can determine what the future holds for patients with specific diseases or medical conditions.

In another article published in BMJ Open, Alan Carr, D.M.D., chair of Dental Specialties at Mayo Clinic, and other authors describe the purpose of adding dental records to the Rochester Epidemiology Project data.

For more information on the history and findings of the Rochester Epidemiology Project, view the new historic timeline.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit mayoclinic.org/about-mayo-clinic or newsnetwork.mayoclinic.org.

About the Rochester Epidemiology Project
The Rochester Epidemiology Project is a collaboration of clinics, hospitals, and other medical and dental care facilities in southern Minnesota and western Wisconsin. Founded by Mayo Clinic and Olmsted Medical Center in 1966 in Olmsted County, Minnesota, the collaboration now stretches across 27 counties, and includes Olmsted County Public Health Services as its first public health member. This collaboration and sharing of medical information makes this area of Minnesota and Wisconsin one of the few places where true population-based research can be accomplished. For more information, visit rochesterproject.org.

MEDIA CONTACT
Traci Klein, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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Common Oral Problems

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ANSWER: Treatment is available for dry mouth. Before you switch to a different medication, there are a number of strategies you can try to reduce this bothersome condition. Because dry mouth puts you at higher risk for dental decay, along with treating your symptoms it is important that you limit the amount of sugar in your diet and take steps to maintain your oral health.

The saliva in your mouth is made in the salivary glands. Those glands are located in front of your ears and near your jaw. Saliva serves a variety of useful purposes. It helps prevent tooth decay by neutralizing acids that bacteria make. It limits bacterial growth in your mouth. Saliva washes away food particles, and enzymes within saliva help with digestion. Saliva also enhances your ability to taste and makes it easier to swallow.

It is common for medications to trigger dry mouth — a condition sometimes called xerostomia. Dry mouth can be a side effect of hundreds of medications, including many over-the-counter drugs. The condition tends to be associated with drugs used to treat depression, nerve pain and anxiety. Dry mouth also is common with the use of some antihistamines, decongestants, muscle relaxants and pain medications.

The severity of dry mouth due to medication varies significantly from one person to another. The main effect is usually a lack of lubrication to your tongue and cheeks that can make it hard to speak, chew or swallow. Other symptoms include dryness in your throat, saliva that seems thick and stringy, bad breath, a changed sense of taste, problems wearing dentures or gum irritation.

Treating dry mouth usually involves both increasing saliva production and managing the effects of dryness on your daily activities.

An easy and inexpensive way to try to stimulate your salivary glands to make more saliva is by chewing sugarless gum. Chewing prompts the glands to make more saliva, and chewing gum takes advantage of that natural reaction. For some people, regularly chewing gum is all they need to ease dry mouth.

If gum is not enough, you may want to talk with your doctor about medications to increase saliva production. Prescription medications such as pilocarpine or cevimeline often are effective, but some people need to take them for up to eight weeks before they start to get relief.

You can try managing dry mouth using a number of techniques to lessen the condition’s effect. For example, eating cool or cold foods that have a high liquid content — such as yogurt, cottage cheese, ice cream or popsicles — can make chewing and swallowing easier. Adding extra liquid to solid foods or blending your foods also can help.

Drink water or other sugar-free liquids or suck on ice chips throughout the day to help moisten your mouth. Avoid beverages that contain alcohol or caffeine, as both can increase dry mouth and cause irritation. Drink plenty of liquids with your meals to make eating solid foods easier.

Over-the-counter products are available that work as saliva substitutes. These products come in a spray that you squirt into your mouth. Although they can effectively add moisture to your mouth, the results usually do not last long. They tend to be most helpful when used to relieve symptoms for a short period of time, such as right before giving a presentation or before eating a meal.

If dry mouth persists despite these measures and becomes a daily nuisance, then consider talking with your doctor about finding a suitable alternative to the medication you are taking that is causing your dry mouth. — Alan Carr, D.M.D., Dental Specialties, Mayo Clinic, Rochester, Minn.

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