Antibiotic prophylaxis for endocarditis, prosthetic joints, and surgery

Department of Restorative Dentistry, Dental School, Framlington Place, Newcastle upon Tyne, NE2 4BW, United Kingdom.
Dental Clinics of North America 11/2002; 46(4):635-51. DOI: 10.1016/S0011-8532(02)00033-2
Source: PubMed


It would seem from a review of the evidence that the need for antibiotic prophylaxis in dentistry is overstated. In simple mathematic terms, the risk for providing coverage is greater than the outcomes that could arise if coverage is withheld. In addition, there is the increasing problem of the development of resistant strains and their impact on medicine and dentistry. Yet despite these observations, the profession continues to put their patients at this greater risk. Medico-legal issues do cloud judgments in this area and many dentists err on the side of caution. The profession does require clear, uniform guidelines that are evidence-based. At present, there is still significant debate as to who is at risk from dental-induced bacteremia and what procedures require chemoprophylaxis.

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    • "The teeth are the only nonshedding surfaces in the body and bacterial levels can reach more than 10 11 microorganisms per mg of dental plaque in healthy individuals (Gendron, et al. 2000, Li, et al. 2000, Lockhart and Durack 1999, Wilson 2001). The accumulation of dental plaque and bacterial colonization of the oropharynx has been associated with a number of systemic diseases including COPD (Scannapieco, et al. 1998), endocarditis (Carmona, et al. 2002, Hoen 2002, Kitten, et al. 2000, Munro and Macrina 1993, Seymour and Whitworth 2002) and bacteremia (Kerr 2000, Marron, et al. 2000). "
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    ABSTRACT: The purpose of this study was to describe the pattern of dental plaque accumulation in mechanically ventilated adults. Accumulation of dental plaque and bacterial colonisation of the oropharynx is associated with a number of systemic diseases including ventilator associated pneumonia. RESEARCH METHODOLOGY/DESIGN: Data were collected from mechanically ventilated critically ill adults (n=137), enrolled within 24 hours of intubation. Dental plaque, counts of decayed, missing and filled teeth and systemic antibiotic use was assessed on study days 1, 3, 5 and 7. Dental plaque averages per study day, tooth type and tooth location were analysed. Medical respiratory, surgical trauma and neuroscience ICU's of a large tertiary care centre in the southeast United States. Plaque: all surfaces >60% plaque coverage from day 1 to day 7; molars and premolars contained greatest plaque average >70%. Systemic antibiotic use on day 1 had no significant effect on plaque accumulation on day 3 (p=0.73). Patients arrive in critical care units with preexisting oral hygiene issues. Dental plaque tends to accumulate in the posterior teeth (molars and premolars) that may be hard for nurses to visualise and reach; this problem may be exacerbated by endotracheal tubes and other equipment. Knowing accumulation trends of plaque will guide the development of effective oral care protocols.
    Full-text · Article · Dec 2011 · Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses
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