Correspondence Address:
Chidambaram Ramasamy
Department of Prosthodontics, Faculty of Dentistry, Asian Institute of Medicine, Science and Technology University, 08100 Semeling, Jalan Bedong, Kedah Darul Aman
Malaysia

Full Text

Sir,

Breast-augmented patients have received consideration in dentistry by virtue of its association with the invasive dental procedures. Overlooking on a surgical perspective, contamination of breast-implant is subsisted to be the infectious complication which eventually leads to implant failure. [1] Majority of infections arise from micro-organisms dwelling in the skin and manifest forth with the repletion of breast augmentation manoeuvre. [1] Conjointly, these contagions can crop up during later periods, but their prevalence is noticed to be sporadic. [1] Rare case report documented by Hunter et al.,[2] states that breast-implant contagion resulted trailing an intrusive dental procedure. Until now, this has been the only evident breast-implant-infected case, where an invasive dental treatment has been responsible for origin of the contagion. This clinical hypotheses enforces the dental practitioners to be alarmed while managing a breast-augmented patient in their hey-day practice. Complications can be anticipated in medical-dental care, despite the proficient's surgery skill, as the implanted device is still acknowledged as alien. But, the fundamental query is how the dental manoeuvre can be a trigger factor for development of a late infection in breast-implant patient?

Clostridium perfringens is the culpable microorganism accounted for bacteremia and persuading to infection in breast-implant patient. [2] Portrayed as gram-positive anerobic bacteria, which is routinely present in gastrointestinal tract and oral flora of human beings. Later type was found unusually in implanted prosthesis on third day after the culmination of treatment for an infected tooth 26 with abscess, where numerous manoeuvres were exercised to restore. Considering the prevailed scenario, Hunter et al., [2] have advocated antibiotic prophylaxis (Cephalosporin) to avert bacteremia in future cases. This statement raised a controversy among other researchers and described the purpose to be extraneous. [3] Authors objected to seek the service of antibiotics owing to the scarcity of evidence in breast-implant infection via dental treatment. [3] Other plausible reason for propagation could be attributed to the adverse effects of antibiotics, if administered without the specific requirement would be hazardous to the patients. [4],[5] The antecedent information, leaves us with a hypotheses that antibiotics are not an absolute indication for the implanted breast patient.

On the contrary, few investigators have elucidated that antibiotic prophylaxis could be rendered to patients presenting with a jeopardized immune. [3] Oral bacteremia could be a precipitating factor in medical-risk-augmented patient where the breast-implant can be prone to infection. [3] Furthermore; radiation effects, chemotherapies, and prevailing neoplasm in breast augmented patient depress the immune system, which enrol them as candidates for antibiotic prophylaxis. [1],[3] Cardinal guideline for dentist's preceding the dental treatment in breast-implant patient is to establish communication with the plastic surgeon and retrieve credible information from their initial conversation relevant to patient's medical status. Administration of antibiotics is intended to be even more secure, when recommended by plastic surgeon before the dental procedure is implemented.

Breast-augmented patient with an endangered immune is more vulnerable to infection, despite the sterilization protocols implemented in dental operatory. Clinicians could deliver productive and protective dental treatment, when the antibiotic prescription is decided on an individual basis.

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