Dental antibiotic prophylaxis

Dental antibiotic prophylaxis is the administration of antibiotics to a dental patient for prevention of harmful consequences of bacteremia, that may be caused by invasion of the oral flora into an injured gingival or peri-apical vessel during dental treatment. This issue remains a subject under constant revision, with the intention of providing recommendations based on sound scientific evidence. Currently, there are official guidelines for dental antibiotic prophylaxis for the prevention of infective endocarditis and of infection of prosthetic joint. These guidelines are in constant controversy and revisions by various professional committees. In addition, there are various medical conditions for which clinicians recommended antibiotic prophylaxis, although there is no evidence to support this practice. These conditions include renal dialysis shunt, cerebrospinal fluid shunt, vascular graft, immunosuppression secondary to cancer and cancer chemotherapy, systemic lupus erythematosus, and type 1 diabetes mellitus.^[1]

It is of importance to dental patients and practitioners to remain current with regards to the latest recommendations rendered by professional governing bodies such as the American Dental Association (ADA), American Heart Association (AHA) and the American Association of Orthopaedic surgeons (AAOS). Antibiotic prophylaxis is intended to avoid adverse outcomes in certain patients at "highest risk of postoperative complications."Standard antibiotic regimens are routinely prescribed and taken before dental procedures to avoid systemic complications secondary to the transient bacteremia caused by manipulation of the oral tissues. Although the ADA, in collaboration with AHA and AAOS have published guidelines specifying those patients who should receive antibiotic prophylaxis, research continues to further define the role dental treatment may play in causing adverse outcomes in these patients. In the past, bacteremia caused by dental procedures (in most cases due to viridans streptococci, which reside in oral cavity), such as a cleaning or extraction of a tooth was thought to be more clinically significant than it actually was. However, it is important that a dentist or a dental hygienist be told of any heart problems before commencing treatment. Antibiotics are administered to patients with certain heart conditions as a precaution, although this practice has changed in the US, with new American Heart Association guidelines released in 2007,^[2] and in the UK as of March 2008 due to new NICE guidelines. Everyday tooth brushing and flossing will similarly cause bacteremia. Although there is little evidence to support antibiotic prophylaxis for dental treatment, the current AHA guidelines are highly accepted by clinicians^[3] and patients.^[4]

See also

• Infective endocarditis
• Preventive medicine
• Oral medicine

References

1. Lockhart PB, Loven B, Brennan MT, Fox PC (April 2007). "The evidence base for the efficacy of antibiotic prophylaxis in dental practice" (PDF). J Am Dent Assoc. 138 (4): 458–74. doi:10.14219/jada.archive.2007.0198. PMID 17403736.
2. Wilson W, Taubert KA, Gewitz M, et al. (October 2007). "Prevention of infective endocarditis: guidelines from the American Heart Association". Circulation. 116 (15): 1736–54. doi:10.1161/CIRCULATIONAHA.106.183095. PMID 17446442.
3. Zadik Y, Findler M, Livne S, et al. (December 2008). "Dentists' knowledge and implementation of the 2007 American Heart Association guidelines for prevention of infective endocarditis". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 106 (6): e16–9. doi:10.1016/j.tripleo.2008.08.009. PMID 19000604.
4. Elad S, Binenfeld-Alon E, Zadik Y, Aharoni M, Findler M (March 2011). "Survey of acceptance of the 2007 American Heart Association guidelines for the prevention of infective endocarditis: a pilot study". Quintessence Int. 42 (3): 243–51. PMID 21465012.