Antibiotic prophylaxis and the medically compromised patient

Antibiotic prophylaxis in oral healthcare – the agreement between Swedish recommendations and evidence

“…Decisions on whether to use antibiotic prophylaxis should weigh the risk of bacteraemia-inducing complications against the risk of adverse events from antibiotics, such as skin rashes, diarrhoea and anaphylaxis, and the risk of developing resistant bacterial strains. 1 In Sweden, most pharmaceutical committees in the counties devote resources to recommendations to support the optimal medication treatment for patients in healthcare. These recommendations include oral healthcare, with advice on when to administer antibiotic prophylaxis in connection Background Almost all (17/20) Swedish counties have pharmaceutical committees that establish recommendations for the use of antibiotic prophylaxis in oral healthcare.…”

Investigation of bacteremia after toothbrushing in orthodontic patients

“…In contrast to the great emphasis given on infective endocarditis originating from dental care, research data showed that only a small percentage of all infective endocarditis cases were related to dental treatment. 6 Some reports have addressed that toothbrushing itself can cause bacteremia 2 and some others not. 3 There is not much information on how to deal with low grade but frequent bacteremia related to everyday events like toothbrushing 12,13,32 or flossing, 33 which have almost the same occurrence rate as dental treatment induced bacteremia and for which antibiotic prophylaxis can not be prescribed.…”

“…It was shown in animal experiments that 10 3 to 10 9 colony forming units of bacteria per milliliter of blood was required to induce infective endocarditis. 6 In the studies on bacteremia related to toothbrushing in orthodontic patients by Chung et al 12 and Schlein et al 13 subjects used toothbrush without toothpaste and none used chlorhexidine or any antiseptic before toothbrushing. In the present study, the control group performed as in the previous studies, but in an effort to simulate the normal situation of the patients, the subjects in the third group were asked to brush their teeth with commonly used toothpaste.…”

“…In healthy individuals, the episodes of transient bacteremia last about 10 -30 minutes, with no dramatic consequences. 6 However, in persons with predisposing factors such as, prosthetic cardiac valves, some forms of congenital heart disease, previous infective endocarditis, and cardiac valvulopathy following cardiac transplantation, transient bacteremia can represent a risk for infective endocarditis. When undertaking dental treatment in these patients, current guidelines of the American Heart Association recommend endocarditis prophylaxis for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.…”

Indications of antibiotic prophylaxis in dental practice–Review

“…Immune compromised patients represent a special division for dental professionals as they are more prone to bacteremia, which may rapidly lead to septecemia [55] . Invasive dental procedure like dental extraction, deep periodontal scaling should be avoided whenever feasible [56] . The dental procedures performed for the immune compromised patients should be carried after interacting with the hematologic, oncologic and microbiologic consultants.…”