Guideline on Antibiotic Prophylaxis for Dental Patients at Risk for Infection

Boboia

Background

Bacteremia is anticipated following invasive dental procedures. Only a limited number of species are implicated in postoperative infections. In 2007 the AHA revised the guidelines for the prevention of IE and reducing the risk of resistant strains of bacteria.

Primary Reasons for Revision:
· “IE is much more likely to result from frequent exposure to random bacteremias associated with daily activities then from bacteremia caused by dental, GI tract, or GU tract procedure”. These daily activities are defined as tooth brushing, flossing, chewing, and use of tooth picks.

· Prophylaxis may prevent an exceedingly small number of cases of IE

· The risk of antibiotic associated adverse events exceeds the benefit

· Maintenance of optimal health and hygiene may reduce the incidence of bacteremia from daily activities and is more important then prophylaxis

Recommendations

Patients with Cardiac Conditions

Prosthetic heart valves, history of IE, unrepaired cyanotic congenital heart disease (CHD), completely repaired congential heart defect with prosthetic material or device during the first 6 months after the procedure, repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or device, and cardiac transplantation recipients who develop valvulopathy. Also patients with a history of IV drug abuse

Antibiotics are recommended for all dental procedures that involve manipulation of gingival tissue of the periapical region of teeth or perforation of the oral mucosa. Please refer to manual or reference guide for dosage information

Patients with Compromised Immunity

Patients with compromised immune systems may not be able to tolerate bacteremia. This may include patients with:

HIV, severe combined immunodeficiency (SCIDS), neutropenia, immunosuppresion, sickle cell anemia, status post splenectomy, chronic steroid use, lupus, diabetes, status post organ transplant

Patients with: shunts, indwelling vascular catheters, or medical devices

· AHA recommends antibiotic prophylaxis only at the time of placement of these devices

· Ventriculoatrial (VA) or Ventriculovenus (VV) shunts for hydrocephalus are at risk of bactermia-induced infections; require prophylaxis

· Ventriculoperitoneal (VP) shunts are not at risk for infection; don’t require prophylaxis

· Plates, pins, screws does not require antibiotic prophylaxis; total knee replacement does not routinely require this either

· Antibiotics may be considered when high risk dental procedures are performed on patients within 2 years following implant surgery or for patients with previous joint infections