Quality Resource Guide

l

Contemporary Approaches to Antibiotic Prophylaxis 1st Edition

4

www.metdental.com

Table 1

15

Dental Procedures for Which Endocarditis Prophylaxis is Reasonable in High Risk Patients:

All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of

the oral mucosa*

The following procedures and events

do not need

antibiotic prophylaxis:

•

Routine anesthetic injections through non-infected tissue

•

Taking dental radiographs

•

Placement of removable prosthodontics or orthodontic appliances

•

Adjustment of orthodontic appliances

•

Placement of orthodontic brackets

•

Shedding of deciduous teeth

•

Bleeding from trauma to the lips or oral mucosa.

*Adapted from Wilson W, Taubert KA, Gewitz M, et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee,

American Heart Association Council on Cardiovascular Disease in the Young, American Heart Association Council on Clinical Cardiology, American Heart

Association Council on Cardiovascular Surgery and Anesthesia, Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of

infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association rheumatic Fever, Endocarditis, and

Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery

and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736–54

The AUC takes into consideration various

scenarios including:

•

Planned dental procedure

•

Immunocompromised status

•

Glycemic control

•

History of peri-prosthetic or deep prosthetic

joint infection of the hip or knee that required

an operation

•

Time since hip or knee joint replacement

procedure

By applying various different scenarios, the AUC

can help a clinician determine when antibiotic

prophylaxis

is

rarely

appropriate,

may

be

appropriate or is appropriate in special patient

circumstances.

It is important to understand that these scenarios

may indeed have some added risk of developing

prosthetic joint infections in a small number of

patients, but they are independent of dental

treatment, since there is no evidence to support an

association between dental procedures and risk of

experiencing prosthetic joint infections.

16

Discussion of available treatment options applicable

to each individual patient relies on obtaining a proper

medical history, open communication between

the patient, dentist, and orthopedic surgeon, and

weighing the potential risks and benefits for that

specific patient.

It is appropriate for the dentist

to make the final judgment to use antibiotic

prophylaxis for patients potentially at higher risk of

experiencing prosthetic joint infection (independent

of dental treatment) using the AUC as a guide,

without consulting the orthopedic surgeon.

16

Conclusion

This report is intended to assist practitioners

with making decisions about the use of

prophylactic antibiotics. The considerations

in this document are not intended to define

a standard of care and should be integrated

with the practitioner’s professional judgment

and the patient’s needs and preference.

The practitioner should also be diligent in

keeping up to date regarding any changes

to guidelines, or new clinical practices

guidelines,

updating

recommendations

for use of antibiotic prophylaxis prior to

dental

procedures.

The

ADA

Website

(

oral-health-topics/antibiotic-prophylaxis

)

is a good site to review any updates.