Guideline on the Use of Antibiotic Therapy of the Pediatric Dental Patients

Guideline on the Use of Antibiotic Therapy of the Pediatric Dental Patients

AAPD Reference Manual V31, No. 6, 2009-10

Intro: Widespread use of antibiotics has resulted in resistance of common bacteria to antibiotics therefore necessitating conservative use of such antibiotics.

Wound Healing: Host factors such as age, systemic disease, malnutrition,and type of wound (clean, potentially contaminated, or dirty) all determine the need for antibiotics. Facial lacerations may require topical antibiotics. Intraoral lacerations contaminated by extrinsic bacteria, open fractures,and joint injuries are at increased risk of infection and thus require antibiotics. If antibiotics are needed, it should be given as soon as possible for the best result in the most effective route whether IV, IM, or oral. Antibiotics should be given for a minimum of 5 days beyond the time of significant improvement.

Special conditions:
Dental origin: If a child presents with acute symptoms of pulpitis, then treatment should be rendered, and usually antibiotics are not indicated. In this situation, the child should have no systemic signs of infection like a fever or facial swelling.

Facial swelling of dental origin: Antibiotics are indicated when there is evidence of facial swelling, and treatment is required immediately.

Dental trauma: Local application of antibiotics to the root of an avulsed tooth with an open apex with less than 60 Minutes of drying time. Systemic antibiotics are indicated with avulsions, usually tetracycline in older individuals and penicillin in younger patients.

Pediatric periodontal disease: Antibiotics are usually indicated due to inadequate immune response to protect against the growth of periodontal pathogens. Culture and susceptibility tests of isolate is helpfule .

Viral disease: Only use antibiotics if one suspects a secondary bacterial infection.

Oral Contraceptive use: Use caution when prescribing antibiotics on patients taking oral contraceptives as the antibiotics decrease the effectiveness of oral contraceptives. Tetracycline and penicillin like medications as well as Rifampicin all decrease plasma levels of ethinyl estradiol , causing ovulation.

Policy on the Management of Patients with Cleft Lip/Plalate and other craniofacial anomalies

Policy on the Management of Patients with Cleft Lip/Plalate and other craniofacial anomalies

Reference Manual: 2009-10

AAPD endorses the statements of the American Cleft Palate-Craniofacial Association (ACPA). In 1991 parameters of care were listed for these patients
1. Management of these patients is best provided by an interdisciplinary team of specialists.
2. Care is best provided by a team with experience in treating a number of patients with craniofacial abnormalities.
3. Best time for a initial evaluation is within the first few weeks of life
4. The team should make every effort to assist the family in adjusting to the birth of the child with various anomalies and the future demands and stress placed on the family.
5. The family should be well informed about treatment decisions and options should be given to encourage participation in these decisions.
6. The team approach to treatment planning recommendations is necessary
7. Care recommended by the team should be provided at the local level as best as possible, and more complex procedures reserved for major medical centers that have experienced providers.
8. Team must be sensitive to extrinsic demographic factors.
9. The team must monitor short-term and long-term outcomes of care.
10. Outcomes must account for satisfaction, psycho-social well-being of the patient as well as the effects on growth, function and appearance.

Dental specialists should also coordinate care between pediatric dentists and orthodontic, oral and maxillofacial surgery and prosthodontic specialists.

Management of Persons With Special Health Care Needs

From Pediatric Dentistry vol. 28 No. 7 reference manual

Guideline on Management of Persons with Special Health Care Needs

Summary by Kris Hendricks

Purpose: AAPD accepts its responsibility to assist in treating this patient population

SHCN definition:

individuals who “have a physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be developmental or acquired and may cause limitations in performing daily self-maintenance activities or substantial limitations in a major life activity. Health care for special needs patients is beyond that considered routine and requires specialized knowledge, increased awareness and attention, and accommodation.”

SHCN patients are more vulnerable to oral disease than the general population.

SHCN disorders that are specifically manifest in the orofacial complex:

• amelogenesis imperfecta
• dentinogenesis imperfecta
• cleft lip/palate
• oral cancer

Disorders that include orofacial problems:

• osteogenesis imperfecta
• ectodermal dysplasia
• epidermolysis bullosa

AwDA defines the dental office as a place of public accommodation. Failure to comply and accommodate SHCN patients is a violation of federal and/or state law.

Difficulties for SHCN patients:

• lack of financial resources
• lack of timely care can lead to more costly episodic care
• medical benefits don’t extend to cover the dental needs
• other health care needs may seem more important than dental
• limited transportation
• complex behavioral problems
• anxiety
• tough to transition these patients from care of pediatric dentist to generalist as they mature

Recommendations:

• strong phone triage at initial contact
• create a dental home--makes SHCN pts less likely to suffer from dental disease
• patient and parent education
• complete med history--updated at every recall
• comprehensive exam and caries risk assessment
• med consults as needed
• must make attempts to communicate with hearing/speaking impaired
• informed consent
• proper behavior management/protective stabilization/sedation/general anesthesia
• be cognizant of psychological well-being of SHCN patients
• make appropriate referrals for things you cannot treat

Preventative strategy

• education of patient and parent
• daily supervision of OH regimen
• Fluoride dentifrice
• electric toothbrush
• dietary counseling
• sealants