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Premedication

 

Premedication for Artificial Joints & Heart Conditions: Please read the following information if you have or have had placement of artificial joints and/or heart conditions.

 

Premedication To Prevent Joint Infections:

The oral cavity is a portal of entry as well as the site of disease for microbial infections that affect general health.

Streptococcus viridian is the main infective agent that can enter the bloodstream from areas with considerable bleeding such as the oral cavity, urinary tract and gastrointestinal tract. This bacteria may lodge on the heart valves, inflame the myocardium and cause ulcerations on the inner walls oFor the first two years following a total joint placement, antibiotic prophylaxis is recommended for everyone. After two years, only high-risk patients may need to receive antibiotics for high-risk procedures.

For the first two years following a total joint placement, antibiotic prophylaxis is recommended for everyone. After two years, only high-risk patients may need to receive antibiotics for high-risk procedures.

Do any of these high-risk situations apply to you?

  • Rheumatoid Arthritis
  • Systemic Lupus
  • Other medical conditions that cause you to be Immunocompromised or Immunosupressed
  • Immunosupression caused by drug or radiation treatment
  • Malnourishment
  • Hemophilia
  • HIV infections
  • Insulin dependent (Type I) diabetes
  • Cancer
  • Some Elderly patients

All patients in these high-risk categories may need antibiotics for all high-risk dental procedures. Premedication is recommended for antibiotic prophylaxis for any dental procedure likely to cause bleeding.

The American Dental Association recommends antibacterial prophylaxis for at-risk individuals with any dental procedure that may cause bleeding such as the following procedures:

  • Tooth extractions
  • Periodontal surgery
  • Scaling & Root Planning
  • Probing
  • Recall maintenance
  • Dental implant placement
  • Replantation of avulsed teeth
  • Subgingival placement of antibiotic fiber or strips
  • Initial placement of orthodontic Bands (not brackets)
  • Intraligamentary local anesthetic injections
  • Cleaning of teeth or implants where bleeding is anticipated
  • Endodontic Surgery
  • Instrumentation beyond the apex

The current regimen (pending any allergies to medications) is two grams of amoxicillin, one hour prior to treatment with no follow-up dosage required. Clindamycin, cephalexin, cefadroxil, azithronycin or clarithromycin as also suggested alternatives.

 

Premedication for Heart Conditions: 

Certain heart conditions are more often associated with endocarditis than others.

Ineffective Endocarditis New guidelines for prevention of infective endocarditis were released by the American Heart Association April 19. The AHA and ADA now recommend that fewer dental patients with heart disease receive antibiotic prophylaxis before dental procedures to prevent the heart infection called infective endocarditis (IE). The guidelines were developed by a group appointed by the AHA that included experts in infectious disease and cardiology and members representing the ADA. The guidelines were endorsed by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society.

After reviewing relevant scientific literature from 1950-2006, the group concluded that bacteremia resulting from daily activities is much more likely to cause IE than bacteremia associated with a dental procedure. In addition, only an extremely small number of IE cases might be prevented by antibiotic prophylaxis, even if prophylaxis is 100% effective. Based on these conclusions, antibiotic prophylaxis is now recommended before dental procedures only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE, such as patients with artificial heart valves, a history of endocarditis, certain serious congenital heart conditions and heart transplant patients who develop a problem with a heart valve.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but NO LONGER need them include:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital heart conditions such as ventricular septal defect, atrial septal defect & hypertrophic cardiomyopathy.

The new guidelines are aimed at patients who would have the greatest danger of a bad outcome if they developed a heart infection.

Preventive antibiotics prior to a dental procedure are advised for patients with:

  1. artificial heart valves
  2. a history of infective endocarditis
  3. certain specific, serious congenital (present from birth) heart conditions, including:
  • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
  • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
  • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device 4. a cardiac transplant that develops a problem in a heart valve.

    The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs. ADA 5/07

    To determine if an existing heart condition poses a risk you will be asked to complete a health history form. You will need to tell us if you have had :
        Heart surgery within the past 6 months
        Artificial heart valve
        Rheumatic Fever
        Pacemaker
        Mitral Valve Prolapse
        Previous Bacterial Endocarditis
        Pulmonary Shunt
        Congenital Heart Defect
        Accuired Valvular Dysfunction
        Within 6 months of Vascular Surgery
          The elderly are at higher risk. More than one half of the current cases of endocarditis occur in people 60 years of age and older with a mortality rate for this group as high as 70%.

          Poor oral hygiene and periodontal (gum disease) or periapical infections increase your risk for endocarditis.

          The American Hearth Association recommends antibacterial prophylaxis for at-risk individuals with any dental procedure that may cause bleeding such as the following procedures:

           
        • Tooth extractions
        • Periodontal surgery
        • Scaling & Root Planning
        • Probing
        • Recall maintenance
        • Dental implant placement
        • Replantation of avulsed teeth
        • Subgingival placement of antibiotic fiber or strips
        • Initial placement of orthodontic Bands (not brackets)
        • Intraligamentary local anesthetic injections
        • Cleaning of teeth or implants where bleeding is anticipated
        • Endodontic Surgery
        • Instrumentation beyond the apex
        •  
          The current regimen (pending any allergies to medications) is two grams of amoxicillin, one hour prior to treatment with no follow-up dosage required. Clindamycin, cephalexin, cefadroxil, azithronycin or clarithromycin as also suggested alternatives.
           
          The most effective reduction in bacteria in your mouth is accomplished by you. It is urgent that you improve your oral hygiene care in order to improve you oral health by
          rinsing your mouth with an antiseptic mouthrinse to reduce the bacteria count in your mouth BEFORE you do the following:
          1. Use a Waterpik irriagator on a daily basis
          2. Brushing at least twice a day for 2 minutes or more using a Sonicare toothbrush
          3. Flossing daily or using an automatic flosser

          All these will "stir up" the bacteria in your mouth, yet by using a consistent and regular self care maintenance routine along with frequent check-ups and professional cleanings will result in an overall reduction of oral bacteria to improve not only your oral health but your total well-being.

           

           

           
             

           

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