| Smile Sense Newsletter |
| Dental Premedication Antibiotic Guidelines Have Changed |
| New guidelines have been issued by the AHA ( American Heart Association) regarding premedicating for dental work and cleanings. In past years, it was believed that IE (Infective Endocarditis) was caused by bacteria in the blood also known as “Bacteremia”. It was believed that after dental procedures, the bacteria in the bloodstream could settle on susceptible areas such as prosthetic valves and so on. New evidence has found many variances. Previous AHA guidelines on the prevention of IE were largely based on opinion and limited studies. The most recent recommendations were devloped through an evidence based approach that was made after 20 years of extensive review. The new recommendation reduces the number of conditions that need premedication. Guidelines went under review due in part to the risk associated with a widespread immunity to antibiotic treatment. Patients with these conditions NO LONGER require prophylactic antibiotic: Mitral valve prolapse Rheumatic heart disease Bicuspid valve disease Calcified aortic stent Congenital heart disease, like ventricular septal defect, atrial defect, and hypertophic cardiomyopathy The new recommendation does suggest antibiotic treatment for the patients with the following conditions: Prosthetic cardic valve Previous infective endocarditis Congential Heart disease(CHD) Unrepaired cyanotic CHD, including pallative shunts and conduits Completely repaired congential heart defect during the first 6 months after the procedure Cardiac transplant pt who devlop cardiac valvulopathy Patients with any of these conditions should consult a medical doctor and bring a letter with your physician’s recommendations to keep in your dental file. For more information, questions, or to schedule an appointment, please call or email us today. |
| Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacement |
| This statement represents the AAOS’ current recommendations on this topic. The AAOS regularly reviews and updates all informational statements as new technology, evidence, or policy is developed. It is possible that these current recommendations may change as the result of the ongoing clinical guidelines development process around the topic of antibiotic prophylaxis for total joint patients undergoing dental procedures. As such, clinicians are encouraged to consider the recommendations in the context of their specific clinical situation and consult, where appropriate, other sources of clinical, scientific, or regulatory information prior to making a treatment decision. Clinicians are encouraged to check the AAOS website for the most up-to-date information. More than 1,000,000 total joint arthroplasties are performed annually in the United States, of which approximately 7 percent are revision procedures.1 Deep infections of total joint replacements usually result in failure of the initial operation and the need for extensive revision, treatment and cost. Due to the use of perioperative antibiotic prophylaxis and other technical advances, deep infection occurring in the immediate postoperative period resulting from intraoperative contamination has been markedly reduced in the past 20 years. Bacteremia from a variety of sources can cause hematogenous seeding of bacteria onto joint implants, both in the early postoperative period and for many years following implantation.2 In addition, bacteremia may occur in the course of normal daily life3-5 and concurrently with dental, urologic and other surgical and medical procedures.5 The analogy of late prosthetic joint infections with infective endocarditis is invalid as the anatomy, blood supply, microorganisms and mechanisms of infection are all different.6 It is likely that bacteremia associated with acute infection in the oral cavity,7,8 skin, respiratory, gastrointestinal and urogenital systems and/or other sites can and do cause late implant infection.8 Practitioners should maintain a high index of suspicion for any change or unusual signs and symptoms (e.g. pain, swelling, fever, joint warm to touch) in patients with total joint prostheses. Any patient with an acute prosthetic joint infection should be vigorously treated with elimination of the source of the infection and appropriate therapeutic antibiotics.8,9 Patients with joint replacements who are having invasive procedures or who have other infections are at increased risk of hematogenous seeding of their prosthesis. Antibiotic prophylaxis may be considered, for those patients who have had previous prosthetic joint infections, and for those with other conditions that may predispose the patient to infection (Table 1). 8,10-16 There is evidence that some immunocompromised patients with total joint replacements may be at higher risk for hematogenous infections.10-18 However, patients with pins, plates and screws, or other orthopaedic hardware that is not within a synovial joint are not at increased risk for hematogenous seeding by microorganisms. Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for joint replacement patients with one or more of the following risk factors prior to any invasive procedure that may cause bacteremia. Table 1. Patients at Potential Increased Risk of Hematogenous Total Joint Infection 8,10-16,18 All patients with prosthetic joint replacement Immunocompromised/immunosuppressed patients Inflammatory arthropathies (e.g.: rheumatoid arthritis, systemic lupus erythematosus) Drug-induced immunosuppression Radiation-induced immunosuppression Patients with co-morbidities (e.g.: diabetes, obesity, HIV, smoking) Previous prosthetic joint infections Malnourishment Hemophilia HIV infection Insulin-dependent (Type 1) diabetes Malignancy Megaprostheses Prophylactic antibiotics prior to any procedure that may cause bacteremia are chosen on the basis of its activity against endogenous flora that would likely to be encountered from any secondary other source of bacteremia, its toxicity, and its cost. In order to prevent bacteremia, an appropriate dose of a prophylactic antibiotic should be given prior to the procedure so that an effective tissue concentration is present at the time of instrumentation or incision in order to protect the patient’s prosthetic joint from a bacteremia induced periprosthetic sepsis. |
| Onondaga County Dental Society sponsors dental evaluations for Special Olympic participants |
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