Dental antibiotic prophylaxis
Encyclopedia
Dental antibiotic prophylaxis is the admission 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.
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, 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 and patients.
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
to a dental
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
for prevention
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
of harmful consequences of bacteremia
Bacteremia
Bacteremia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal....
, that may be caused by invasion of the oral
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
flora
Flora
Flora is the plant life occurring in a particular region or time, generally the naturally occurring or indigenous—native plant life. The corresponding term for animals is fauna.-Etymology:...
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
Scientific evidence
Scientific evidence has no universally accepted definition but generally refers to evidence which serves to either support or counter a scientific theory or hypothesis. Such evidence is generally expected to be empirical and properly documented in accordance with scientific method such as is...
.
Currently, there are official guidelines for dental antibiotic prophylaxis for the prevention of infective endocarditis
Infective endocarditis
Infective endocarditis is a form of endocarditis, or inflammation, of the inner tissue of the heart, such as its valves, caused by infectious agents. The agents are usually bacterial, but other organisms can also be responsible....
and of infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
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
Shunt (medical)
In medicine, a shunt is a hole or a small passage which moves, or allows movement of fluid from one part of the body to another. The term may describe either congenital or acquired shunts; and acquired shunts may be either biological or mechanical.* Cardiac shunts may be described as...
, cerebrospinal fluid
Cerebrospinal fluid
Cerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...
shunt, vascular graft, immunosuppression
Immunosuppression
Immunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other...
secondary to cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
and cancer chemotherapy, systemic lupus erythematosus
Systemic lupus erythematosus
Systemic lupus erythematosus , often abbreviated to SLE or lupus, is a systemic autoimmune disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage...
, and type 1 diabetes mellitus.
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
American Dental Association
The American Dental Association is an American professional association established in 1859 which has more than 155,000 members. Based in Chicago, the ADA is the world's largest and oldest national dental association and promotes good oral health to the public while representing the dental...
(ADA), American Heart Association
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
(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
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
regimens are routinely prescribed and taken before dental procedures to avoid systemic complications secondary to the transient bacteremia
Bacteremia
Bacteremia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal....
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
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
procedures (in most cases due to viridans streptococci
Streptococcus viridans
Viridans Streptococcus is a pseudotaxonomic non-Linnaenan term for a large group of commensal streptococcal bacteria that are either α-hemolytic, producing a green coloration on blood agar plates , or nonhemolytic...
, which reside in oral cavity), such as a cleaning or extraction
Extraction (dental)
A dental extraction is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to render the tooth non-restorable...
of a tooth
Tooth
Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are...
was thought to be more clinically significant than it actually was. However, it is important that a dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
or a dental hygienist
Dental hygienist
thumb|right|300px|Dental hygienist holding a scalerA dental hygienist is a licensed dental professional who specializes in preventive oral health, typically focusing on techniques in oral hygiene. Local dental regulations determine the scope of practice of dental hygienists...
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, 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 and patients.