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THE NEED FOR ANTIBIOTIC PROPHYLAXIS IN CLIENTS
WITH UNDERLYING CARDIAC CONDITIONSLauren McMeekin, Valerie Cote & Morgan Milligan
PICO QUESTION
In clients with underlying heart conditions, does premedication reduce the risk of infective endocarditis, compared to no premedication during dental prophylaxis?
P = clients with underlying heart conditionsI = prophylaxis antibiotic C = no prophylaxis antibioticO = reduction in infective endocarditis
WHAT IS INFECTIVE ENDOCARDITIS?
It is defined as an infection caused by bacteria entering the blood stream and attaching itself to the heart chamber linings (Chen, Tung, Wu, 2015)
It is an inflammation of the inner tissues of the heart, the endocardium, usually of the valves. It is caused by infectious agents, or pathogens, which are largely bacterial but a few other organisms can also be responsible.
WHAT IS ANTIBIOTIC PROPHYLAXIS?An antibiotic given in order to prevent infection complications prior to treatment. Bacteria is more likely to enter the blood stream while at the dentist and undergoing care. Antibiotic prophylaxis will prevent any risk of developing infective endocarditis.
WHY?Many dental clients often have underlying factors that increase the chance of obtaining infective endocarditis
People with underlying cardiac conditions are the one’s that require the premedication
GUIDELINESThe guidelines state that prophylactic antibiotics, which were routinely administered to certain patients in the past, are no longer needed for patients with:
mitral valve prolapse
rheumatic heart disease
bicuspid valve disease
calcified aortic stenosis
congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.
(Prevention of Enodcarditis, CDA, 2016)
UNDERLYING CONDITIONS
Some underlying conditions that require premedication's:
prosthetic cardiac valve or prosthetic material used for cardiac valve repair
history of infective endocarditis
cardiac transplants that develop cardiac valvulopathy
Congenital
unrepaired cyanotic congenital heart disease
palliative shunts and conduit a
completely repaired congenital heart defect with prosthetic material or device
any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
NO ANTIBIOTIC PROPHYLAXIS?
Some studies have shown that not everyone with a heart condition need to take a pre medication prior to invasive dental treatment
A study in Minnesota found that there was not a significant increase in infective endocarditis within three months preceding dental treatment, supports the fact that premedication is unnecessary for dental prophylaxis (Wilson et al., 2008.)
ADA guidelines note that people with IE are exposed to the same bacteria from daily oral hygiene routines.
Many forget to take it, or lie about taking it.
COUNTER ARGRUMENT
OVER PRESCRIBING?
Due to over prescribing of antibiotics, there may be an increased risk of antibiotic resistance in some individuals.
With all the different studies that have been done, there is no significant proof that there is a need for an antibiotic prophylaxis in certain cardiac cases.
DENTAL PROCEDURES THAT CONSIST OF THE INVASION OF GINGIVAL TISSUE Assessment; probing and exploration
Debridement, calculus and plaque removal
Polish, dental prophylaxis
All of which can induce perforation of the oral mucosa
All treatments that require a prophylaxis prior to treatment for any client with an underlying cardiac condition (Wilson et al., 2008).
Invasive treatment creates blood which leads to bacteria getting into the blood stream causing infection (Sroussi, Epstein, Prabhu, 2007).
CONT..
Taking antibiotic prophylaxis provides an extra barrier to lower the risk of contracting infection.
Evidence shows that the risk may occur within two weeks following that dental procedure, but with many studies there has been evidence that the infection can be caused by dental procedures performed months earlier (Sroussi, Epstein, Prabhu, 2007).
BEING AWARE AND UP TO DATE IS KEYEvery dental practitioner must follow most up to date standards in order to provide the best care.
Following guidelines creates high standards of care and defines medicolegal standards (Sroussi, Epstein, Prabhu, 2007).
Must always be taken seriously when a client has a need for premedication
CONT..
Canadians can choose to follow the American guidelines or a British society guideline
Which ever one your office follows it must always be followed to best standards
CONCLUSION
Client’s medical history must always be taken into consideration in order to confirm if the client will require an antibiotic prophylaxis
Dental staff must always follow the prompt guidelines to ensure the optimal care for clients
Take every precaution that is necessary
Essential for a client with an underlying cardiac condition
Antibiotic pre medication is still necessary for client that may be susceptible to infective endocarditis
REFERENCESAmerican Dental Association. (2016, May). Retrieved from http://www.ada.org/en/member center/oral- health-topics/antibiotic-prophylaxis
Chen, P., Tung, Y., Wu, P. W., Wu, L., Lin, Y., Chang, C.,…Chu, P. (2015). Medicine. Dental Procedures and the Risk of Infective Endocarditis. 1-6. Retrieved from,
file:///C:/Users/Morgmill/Downloads/DentalProceduresandtheRiskofInfectie.41pf
Glasscoe, D.D. (n.d.). New Premedication Guidelines. Retrieved from,http://www.rdhmag.com/articles/print/volume-28/issue-1/columns/staff-rx/newpremedication- guidelines.html
Sexton, D. J. (2016, June). Patient information: Antibiotics before procedures (Beyond the Basics). Retrieved from http://www.uptodate.com/contents/antibiotic beforeprocedures-beyond-the-basics
Sroussi, H. Y., Epstein, J. B., & Prabhu, A. R. (2007, June). Which Antibiotic Prophylaxis Guidelines for Infective Endocarditis Should Canadian Dentists Follow?. Retrieved from, https://www.cda-adc.ca/jcda/vol- 73/issue-5/401.pdf
Wilson, W., , Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison, M.,…Bolger, A. (2008). Prevention of infective endocarditis: Guidelines from the American Heart Association. JADA, Vol. 139 Retrieved from, http://jada.ada.org/article/S0002-8177(14)627458/pdf