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Ask the Doctor: Oh, that infectious grin

Dear Velo,I can't believe I read at the beginning of the Tour that Tom Boonen was given an antibiotic for the "minor infection" that had caused a major toothache. In the dawn of time, when I was racing, an antibiotic would wipe me out for about two weeks, simply due to the fact that, as a broad-spectrum bug killer, it will kill intestinal flora, too. This means that I would get diarrhea and have poorer nutritional uptake from food. The same will be true for Tom. The other point to wonder about here (and I realize the difficulty of diagnosing from an article) is what caused the toothache?

By Dawn M. Richardson, MD, FACEP

Dear Velo,
I can’t believe I read at the beginning of the Tour that Tom Boonen was given an antibiotic for the “minor infection” that had caused a major toothache. In the dawn of time, when I was racing, an antibiotic would wipe me out for about two weeks, simply due to the fact that, as a broad-spectrum bug killer, it will kill intestinal flora, too. This means that I would get diarrhea and have poorer nutritional uptake from food. The same will be true for Tom. The other point to wonder about here (and I realize the difficulty of diagnosing from an article) is what caused the toothache? In my 20 years as a dentist, there are a couple of things that will do this. Decay going to the nerve, a cracked tooth, a leaking filling, a gum infection are some of them. Gums don’t get infected if the person has more than a passing relationship with their toothbrush. Neither a cracked tooth nor a leaking filling will be helped at all by an antibiotic. That leaves decay. Why wasn’t this fixed in the off season? Do riders have a thorough dental checkup at the same time they have their pre-season medical checkup? If the problem is one of decay-to-the-nerve, the only treatment is root canal therapy (and, BTW, it is the need for treatment that is causing the pain, not the treatment…). Since this takes about two hours to complete on a new patient, why was this not done for Mr. Boonen? It would have solved the problem and would not have needlessly exposed him to a removal of his nutritional flora.
Ben Schultz, DDS, MAGD
Fairfield, Connecticut

Dear Dr. Schultz,
First let me dispute your claim that antibiotics are the cause of feeling wiped out. How about the bacterial illness that the antibiotics are being used to treat? There is a widely held myth among many athletes and cyclists in particular that antibiotics are bad and can make you sick. How about untreated bacterial infections? I’m the first to agree that antibiotics are overused, but when necessary, they make a huge difference. I know this is only an anecdote but I recently treated a very sick athlete with antibiotics for resistant bronchitis 10 days before the athlete won a national championship. If the antibiotic doesn’t agree with your intestines, switch antibiotics or eat yogurt to promote the normal intestinal flora. Also, ladies if you always develop a yeast infection on antibiotics speak up and this can be co-treated preventatively.

As for Tom Boonen’s bad teeth, I’d say up to 5 percent of my emergency medicine practice is 3-in-the-morning dental pain. Nothing personal, but lots of people are afraid or too cheap to go to the dentist for checkups and think dentists do nothing but pull rotten teeth.

I hate to say it but I don’t think European team doctors always have the athletes’ health in mind; they are there to ensure performance. How could Lance Armstrong have gone so long without a testicular cancer diagnosis if he were being closely watched medically? Boonen probably had a bad tooth and kept quiet about it until his face swelled up. Athletes are, for any number of reasons, sometimes foolishly motivated to cover up minor health problems. I strongly recommend that dental and physical checkups should be on every cyclist to do list at the beginning of the off-season. You’d rather deal with these problems in October than April.
Dawn Richardson


Dawn Richardson retired from the women’s peloton as a category 2 on the Verizon Wireless-Cervelo Women’s Cycling Team at the end of 2002 after 13 racing seasons. She is a board-certified emergency medicine physician practicing at Roger Williams Medical Center in Providence, Rhode Island, and is a clinical instructor in emergency medicine at Brown Medical School. Send your questions to her atwebletters@insideinc.com.Important note
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