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.

VIDEO

https://www.youtube.com/watch?v=FDB0VDZxoNw

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