-
Antibiotic Prophylaxis is done?
Prior to Dental Procedures
-
Antibiotic resistance
- certain bacteria have become resistant
- (CDC) calls "one of the world's most pressing public health problems."
-
Dental Procedures that require Pre-Med:
- manipulation of gingival tissue
- periapical region of the teeth
- perforation of the oral mucosa
-
Dental Procedures that DO NOT require Pre-Med:
- Routing anesthetic injections through non-infected tissue
- Radiographs
- Placing, adjusting or removing prosthodontic / ortho appliances
- Bleeding from trauma
- Shedding of primary teeth
-
Prosthetic Joint Patient
- “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.”
- failed to demonstrate an association between dental procedures and prosthetic joint infection
-
Infective endocarditis
- current guidelines support infective endocarditis premedication for a relatively small subset of patients:
- -the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis
- -Patients at risk: and daily oral activity
-
Infective endocarditis Patient Selection:
- prosthetic cardiac valves
- prosthetic material used for cardiac valve repair
- a history of infective endocarditis
- a cardiac transplant with valve regurgitation due to a structurally abnormal valve
- the following congenital (present from birth) heart disease:
- -unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- -any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device
-
When a patient Needs Pre-Med
Consultation w/orthopedic surgeon
- orthopedic surgeon recommend the appropriate antibiotic regimen
- write the prescription
-
When a patient Needs Pre-Med
patients forget to premedicate before their appointments
- the antibiotic must be given before the procedure
- allows the antibiotic to reach adequate blood levels
-
When a patient Needs Pre-Med
EXCEPTION:
- infective endocarditis state, “If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to 2 hours after the procedure.”
- Back to back appointments = the antibiotic prophylaxis regimen should be repeated prior to the second appointment.
-
When a patient Needs Pre-Med
patients who require prophylaxis but are already taking antibiotics for another condition
- guidelines for infective endocarditis recommend that the dentist select an antibiotic from a different class than the one the patient is already taking.
- For example, if the patient is taking amoxicillin, the dentist should select clindamycin, azithromycin or clarithromycin for prophylaxis.
-
How much and when? Prophylactic Regiment
Table 10-4 Wilkins page 169
-
-
-
|
|
