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Conditions Requiring Antibiotics Before Dental Treatment

Antibiotic Prophylaxis implies taking antibiotics prior to routine dental care to prevent possible infection in those at risk. There are many medical conditions (see below) that place you at some risk when visiting the dental office for cleanings, fillings and minor oral surgical procedures. Certain categories of invasive dental treatment are known to produce significant bacteremia (infections). Such bacteremia, although transient, may be detrimental to the health of patients with a variety of medically compromising conditions and pre treatment with antibiotic prophyla!is may be indicated. "f your medical team suggests that you are at risk then you should have a prescription for an antibiotic prior to having all you future dental appointments. Typically you would have a # gram dose of amo!icillin (pending no allergy) $ hour prior to the dental appointment each time you visit the dental office. "t is important to keep your dental office updated with your medical health changes. %lease print this form and show it to your medical doctor if you have any of the following conditions prior to your ne!t dental appointment. &ither your dentist or your '( can call a prescription into the pharmacy for you to take prior to your dental appointment if you are at risk. ANTIBI TIC PR P!"#A$I% & R D'NTA# PATI'NT% AT RI%( C)*("T")*S +), -."C. ANTIBI TIC PR P!"#A$I% I% R'C ))'ND'D/ %revious episode of infective bacterial endocarditis .eart valve replacement, including bioprosthetic and homograft valves ,ecent surgical repair of cardiovascular defects within the past si! months Surgical systemic to pulmonary artery shunts or conduits ,heumatic heart disease or other ac0uired heart disease 'itral or aortic valvulitis .ypertrophic cardiomyopathy Congenital heart disease 1entricular septal defects (unrepaired) %atent ductus arteriosus Coarctation of the aorta Tricuspid valve disease 2symmetric septal hypertrophy Tetralogy of +allot Antibiotic Prophylaxis is recommended continued

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2ortic stenosis %ulmonic stenosis Comple! cyanotic heart disease Single ventricle states Transposition of the great arteries 3icuspid aortic valve "diopathic hypertrophic subaortic stenosis (".SS) "ndwelling vascular catheter (such as %ortacaths) ,enal dialysis with arteriovenus shunt appliance 'itral valve prolapse ('1%) with mitral insufficiency, regurgitation, thickened leaflets and 4 or holosystolic murmur %ost mitral valve surgery 1entriculoatrial (12) shunts for hydrocephalus 1entriculovenus (11) shunts for hydrocephalus "mmunocompromised patients where the -3C is 5677 cells 4mm5 (5.6 84mm5) or less, or the 2*C is 677 cells 4mm5 (7.6 84mm5) or less/ Cancer chemotherapy 2"(S 3lood dyscrasias Transplant recipients (including organ transplants, bone marrow transplants and stem cell transplants)

C)*("T")*S +), -."C. 2*T"3")T"C %,)%.9:2;"S %! *#D B' C N%ID'R'D/ &!tractions or bony surgery planned in previous radiation field "mmunocompromised patients where the 2*C is $777 cells 4mm5 ($.7 84mm5) or less +irst two years following <oint replacement in patients with immunocompromising conditions =ncontrolled or poorly controlled diabetes Systemic lupus erythematosus "n<ection drug users :onger antibiotic prophyla!is schedules should be considered for/ &!tractions or bony surgery planned in previous radiation field =ncontrolled or poorly controlled diabetes Cancer chemotherapy

C)*("T")*S +), -."C. 2*T"3")T"C %,)%.9:2;"S "S N T R'C ))'ND'D/ %hysiologic, functional or innocent murmurs .istory of rheumatic fever without clinical heart disease =ncomplicated secundum atrial septal defect 'itral valve prolapse ('1%) without mitral insufficiency, regurgitation or a murmur Coronary artery stenosis Cardiac pacemaker

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2therosclerotic heart disease Swan >an? catheter -ell controlled diabetes "mmunocompromised patients with the 2*C of $777 cells 4mm5 ($.7 84mm5) or greater Si! months or longer after surgery for/ Coronary artery bypass graft (C23>) :igated patent ductus arteriosus 1ascular grafts (autogenous) Surgically closed atrial or ventricular septal defects (without dacron patches) "n the absence of associated heart disease/ Sickle cell anemia Cystic fibrosis Simple orthopedic metallic devices, including pins and plates

3ackground "nformation C N%ID'RATI N% R'+ ANTIBI TIC PR P!"#A$I% & R D'NTA# PATI'NT% AT RI%(

These recommendations are based upon a variety of in vitro studies, clinical experience, animal model data and an assessment of the common oral flora most likely to cause potential bacteremia. Definitive patient risk/benefit ratios for these prophylactic procedures have not been definitively determined nor have they been medically or scientifically proven to be effective by well designed controlled human trials (with or without randomization .
Dental procedures ,hich may produce significant bacteremia include all procedures where significant oral bleeding and4or e!posure to potentially contaminated tissue is anticipated. These procedures may include, but are not limited to, dental e!tractions and other oral surgery, sub gingival scaling and the sub gingival placement of dental dam clamps or orthodontic bands. Such procedures would typically re0uire antibiotic prophyla!is in patients at risk. Simple ad<ustment of orthodontic appliances, tooth brushing or spontaneous loss of primary teeth do not re0uire antibiotic prophyla!is. %atients at risk would include those with cardiac deformities, those with artificial devices in the circulatory system, and those with immunocompromising conditions. %atients with cardiac deformities should receive antibiotic prophyla!is according to the current guidelines of the 2merican .eart 2ssociation. Consultation with the patient@s physician may be re0uired. %atients with artificial devices in the circulatory system should receive antibiotic prophyla!is using the current protocols of the 2merican .eart 2ssociation. Such patients would include, but not be limited to, those with heart valve replacement including bioprosthetic and homograft valves, recent surgical repairs of cardiovascular defects within the past si! months, and indwelling shunts or conduits

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(such as patients with indwelling central lines or vascular access catheters, such as %ortacaths, for cancer chemotherapy, ventriculoarterial or ventriculovenus shunts for hydrocephalus and arteriovenus shunts for hemodialysis). Consultation with the patient@s physician may be re0uired.

%atients with a variety of immunocompromising conditions should receive antibiotic prophyla!is using the current protocols of the 2merican .eart 2ssociation. Such patients would include, but not be limited to, those with a suppressed leukocyte count (such as cancer chemotherapy, 2"(S, blood dyscrasias, transplant recipients) where the white blood cell count (-3C) is less than 5677 cells 4mm5 (5.6 84mm5) or the absolute neutrophil count (2*C) is less than 677 cells 4mm5 (7.6 84mm5). Consideration for antibiotic prophyla!is should be given for other patients with an impaired immune system or those with delayed healing, such as those with, but not limited to, patients with previous radiation therapy where planned e!tractions or other bony surgery is in the radiation field, patients with an 2*C less than $777 cells 4mm5 ($.7 84mm5), uncontrolled diabetes, systemic lupus erythematosus and in<ection drug users. Consideration should be given for longer antibiotic prophyla!is schedules (seven to ten days or longer) for those patients where delayed healing following invasive procedures would further e!pose those patients at risk to ongoing bacteremia. Consultation with the patient@s physician may be re0uired. The C(2 adopts the position of the 2merican (ental 2ssociation regarding antibiotic prophyla!is for dental patients with total <oint replacement and thus, patients with total <oint replacement should typically not receive antibiotic prophyla!is. Chemoprophyla!is, however, should be considered for patients with immunocompromising conditions, particularly patients during the first two years following <oint replacement. Consultation with the patient@s orthopedic surgeon may be re0uired. http/44www.aaos.org4wordhtml4papers4advistmt4denta.htm Conditions which generally do not re0uire antibiotic prophyla!is would include, but not be limited to, physiologic, functional or innocent murmurs, a history of rheumatic fever without residual clinical heart disease, uncomplicated secundum atrial septal defect, mitral valve prolapse without mitral insufficiency, regurgitation or a murmur, coronary artery stenosis, cardiac pacemakers, atherosclerotic heart disease, well controlled diabetes, immunocompromising conditions without decreased -3C or 2*C, sickle cell anemia, cystic fibrosis or other simple orthopedic metallic devices. Consultation with the patient@s physician may be re0uired. %atients at risk re0uiring antibiotic prophyla!is who are already receiving an antibiotic for a pree!isting condition should receive an antibiotic for prophyla!is from a different classification. +or e!ample, a patient at risk already receiving a penicillin for some other condition should receive another antibiotic for prophyla!is, such as clindamycin. %atients at risk should establish and maintain the best possible oral health to reduce potential sources of bacterial infection. &very attempt should be made to reduce gingival inflammation in patients at risk by means of brushing, flossing, topical fluoride therapy, antimicrobial rinses and professional cleaning before proceeding

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with routine dental treatment. "n order to help prevent the development of resistant strains, antibiotics should not be used indiscriminately. Complications associated with the use of antibiotics include to!ic and allergic reactions, superinfections and the development of resistant organisms. "t is essential that practitioners be well informed about the actions and reactions of any drugs they prescribe or administer and must be prepared to handle any reasonably foreseeable complication, including anaphyla!is. &ach health care professional is ultimately responsible for his or her own treatment decisions. These guidelines have been adapted with permission from the 2merican 2cademy of %ediatric (entistry ,eference 'anual $AAB $AAC, 2ntibiotic Chemoprophyla!is for %ediatric (ental %atients at ,isk. ,eprinted from Canadian (ental 2ssociation 2pproved by ,esolution AA.$C Canadian (ental 2ssociation 3oard of >overnors 'arch, $AAA

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