Dental antibiotic prophylaxis

Currently, there are official guidelines for dental antibiotic prophylaxis for the prevention of infective endocarditis and of infection of prosthetic joint. These guidelines are in constant controversy and revisions by various professional committees. In addition, there are various medical conditions for which clinicians recommended antibiotic prophylaxis, although there is no evidence to support this practice. These conditions include renal dialysis shunt, cerebrospinal fluid shunt, vascular graft, immunosuppression secondary to cancer and cancer chemotherapy, systemic lupus erythematosus, and type 1 diabetes mellitus. It is of importance to dental patients and practitioners to remain current with regards to the latest recommendations rendered by professional governing bodies such as the Scottish Dental Clinical Effectiveness Programme (SDCEP), American Dental Association (ADA), American Heart Association (AHA) and the American Association of Orthopaedic surgeons (AAOS). Antibiotic prophylaxis is intended to avoid adverse outcomes in certain patients at "highest risk of postoperative complications." Standard antibiotic regimens are routinely prescribed and taken before dental procedures to avoid systemic complications secondary to the transient bacteremia caused by manipulation of the oral tissues. Although the ADA, in collaboration with AHA and AAOS have published guidelines specifying those patients who should receive antibiotic prophylaxis, research continues to further define the role dental treatment may play in causing adverse outcomes in these patients. == Recommendations ==

The Scottish Dental Clinical Effectiveness Programme (SDCEP) had published recommendations in this scope (August 2018) for the dental team on how best to adhere to the guidelines by NICE. These recommendations have been recognised and acknowledged by NICE in July 2018. The recommendations aim to clarify circumstances and management when patients are not within the scope of NICE's guideline on antibiotic prophylaxis. • Considerations should be undertaken by healthcare professional as well to exercise their clinical judgement and patient's consent in decision-making. Infective Endocarditis (IE) is the infection of heart valves. Previous beliefs were held that IE can be induced from dental procedures due to the invasive nature of treatment, therefore antibiotics were widely prescribed before dental treatment to prevent this. This belief has changed with evidence to show that the risk of IE occurrence from everyday routine such as toothbrushing and eating is the same as that of undergoing invasive dental procedure. Increasing concerns regarding rise in antibiotic resistance have also pushed for change in advice on antibiotic prophylaxis, where the British National Formulary (BNF) has now opposed the use of antibiotic prophylaxis in dentistry. • Unsatisfactory evidence to conclude whether antibiotic prophylaxis is useful in patients at risk of IE before dental treatment. It is now established that Antibiotic prophylaxis against IE is not recommended routinely for people undergoing dental procedures according to NICE 2016, recommendation 1.1.3. Group of patients with higher risks Only a selected body of patients are categorized with a more significant risk of IE who might require antibiotic prophylaxis. These patients undergo non-routine management. Emergency patients with cardiac conditions Check patient's cardiac condition and determine whether they belong in the selected body of patients who are at a more significant risk of IE. Consulting with a local cardiology centre or the patient's cardiologist may be appropriate. Manage infections without delay to minimise risk of IE development. Prescribing antibiotics • It should be clear on the prescription that the antibiotics serve as prophylaxis • Inform patients about the risks and possible side effects on prescribed drugs, how to seek help if side effects occur • Inform patients on appropriate use of antibiotics (duration, time, route of administration) == See also ==