2.+Need+for+Prophylactic+Premedication



**Need for Prophylactic Premedication**Week 2 big idea:

Guideline on Antibiotic Prophylaxis for Dental Patients at Risk for Infection. (2011). //Pediatric Dentistry//, //33//(6), 265-269.

Both Carranza and the article from the journal of American Academy of Pediatric Dentistry talks about the use of antibiotic prophylaxis for patient who are at risk for development of infective endocarditis. They both describe the causative agents of infective endocarditis, symptoms, and identify patient who are susceptible to condition. Journal of American Academy of Pediatric Dentistry provide recommendations and state controversies associated with the prophylactic antibiotics. (Yelena Bobova#23)

Gopalakrishnan, P.R., Shukla, S. K., & Tak, T. (2009). Infectice Endocarditis: Rationale for Revised Guidelines for Antibiotic Prophylaxis. //Clinical Medecine and Research//, 7(3), 63-68. doi:10.3121/cmr.2009.848

After reading Carranza and my article, the information given both coincide with one another. Carranza states that although the occurrence rate of IE is low, the presence of it can be life threatening. It is important to identify the patient that may be susceptible to IE and proper antibiotic prophylaxis must be used prior to any periodontal treatment. Carranza addresses the issue of the formation of resistant strains of bacteria due to the extended use of antibiotics. This was also a point of interest in the article that I read. Also, Carranza also states that there is no evidence for the need of antibiotic prophylaxis. The article that I researched also mentioned the fact that there is no evidence that proves or disproves the use of antibiotic premed for IE. (Elina Sandoval) --Asia Hernandez 28-- Carmona, I., Dios, P., & Scully, C. C. (2007). Efficacy of antibiotic prophylactic regimens for the prevention of bacterial endocarditis of oral origin. //Journal of dental research//, //86//(12), 1142-1159. Retrieved from []

Carranza and the article I chose both talk about how premedication for endocarditis is critical to reduce levels of bacteria in the blood to prevent its spread to the heart. Because the epithelium of the heart is compromised in someone who has cardiac injury or valvular conditions, it is also essential to consider the best possible means to protect the person from any risky situations, and this includes following standard pre-medication procedures. However, the article I chose went more into evidence based research on the controversies that arise based on timing, type of antibiotic, and efficacy of prophylactic premedication. --Asia Hernandez 28--

Morris, A. M. Antibiotics before dental procedures for endocarditis prophylaxis: back to the future [Editorial]. //Heart and Education on Heart//, //86//(1). Retrieved February 23, 2012, from [] The artical I chose and Carranza share the same view in that IE is of low incidence in denistry and that the AHA recommends pre-med before oral procedures. However my artical seemed to focus on the risks of antibiotic prophylaxis such as antibiotic resistance and the drug resistant micro-organisims. It also noted that there has been a lack of prospective and controlled studies that examine the effectiveness of pre-medication for dental procedures. Carranza seemed to focus on how to provide OH for a person that has IE and what the best periodontal treatment would suit the patient. Also noted pre treatment and home care for the patient. Candice Adams

The article I choose just recommend that the need for antibiotic prophylaxis should be revised with patient with IE and that there is a greater risk for developing anaphylactic reactions even if having an allergy to penicillin or not having a known allergy to penicillin. According to Caranza the American Heart Association still recommends that there is a need for antibiotic prophylaxis for procedures involving significant amount of bleeding from hard and soft tissue. The debate continues because bacteremia can occur with or without the presence of dental procedures. * Monica Gutierrez#27*

Wray, D., Ruiz, F., Richey, R., & Stokes, T. (2008). Prophylaxis against infective endocarditis for dental procedures-summary of the NICE guideline. British Dental Journal, 204(10), 555-557. The article I read regarding the National Institute of Health and Clinical Excellence (NICE) guidelines and the information in Caranza both talk about how infective endocarditis is a rare condition, although life-threatening for those who are susceptible to it. Both the article and Caranza also explain how it is important to maintain good oral hygiene as part of the prevention of IE because this prevents the build-up of bacteria in the oral cavity. That is where the similarities seem to end. The NICE guidelines contradict the AHA recommended guidelines for the use of prophylactic antibiotics prior to dental treatment for those who are at risk of IE. The NICE guidelines recommend that prophylactic antibiotics should not be given prior to dental treatment for anyone, even those susceptible to IE. Their basis to support their view is that there is no clinical data showing the effectiveness of prophylactic antibiotics in the prevention of IE.Their guidelines also say that tooth brushing for patients with periodontal disease on a regular basis would constitute a higher risk than a single dental procedure, due to repetitive exposure to bacteria entering the bloodstream. Their findings recommend using antibiotics only in cases of infection in the tissues of the oral cavity – if it occurs – as that would be a continuous source of bacterial infection into the bloodstream. Finally they say that prophylactic antibiotics may lead to more deaths than IE due to fatal anaphylaxis from allergic reactions to the antibiotic. Elena Salas-33 --- Enzler, M., Berbari, E., & Osmon, D. (2011). Antimicrobial prophylaxis in adults. //Mayo//

//Clinic Proceedings. Mayo Clinic//, //86//(7), 686-701.

Infective endocarditis is rare but if it occurs the prognosis is poor that is why premedication is so important before dental procedures, even if the patient is at a greater risk during their normal daily activities; like brushing their teeth and flossing. The article and Carranza both state that the patient should maintain optimal oral health to reduce the risk of developing infective endocarditis during a dental procedure. Also stated is that there isn’t any scientific evidence that shows that premedication prevents prosthetic joint infection after dental treatment, but it is recommended. The article does discuss the risk of antibiotic toxicity, high incidences of allergic reaction to the antibiotics, and the risk of developing drug resistant bacteria. Lauren Cadena #38 --

Porat Ben-Amy, D., Littner, M., & Siegman-Igra, Y. (2009). Are dental procedures an Important risk factor for infective endocarditis? A case-crossover study. //European// // Journal Of Clinical Microbiology & Infectious Diseases: Official Publication Of The //// European Society Of Clinical Microbiology //, //28//(3), 269-273

The big idea of the article I researched is that the chances of getting infective endocarditis is not really increased from having a dental procedure, that its risk is so low and is more commonly caused by brushing and flossing. Carranza also mentions that bacteremia may occur even in the absence of dental procedures, such as individuals with poor oral hygiene and significant periodontal inflammation. Carranza also explains that even though the incidence of infective endocarditis is low, it is a serious disease and the prognosis is very poor. Basically we as clinicians need to evaluate the patient to determine if the patient is at risk and really focus on educating the patient about how to avoid getting IE from having inflammation periodontal disease. And explain that all of the bacteria in their mouth could cause this deadly disease. Amber Starnes 36

ACS #35  The article that I selected and the reading from Carranza share the same conclusion that infective endocarditis risk is higher in individuals with predisposing conditions, such as prosthetic heart valves and shunts,immunosuppression, history of IE and therefore antibiotic prophylaxis for dental procedures in the prevention of IE in this population is supported. My article focused on odontogenic infections and the bacteria that are known to be related to IE causing diseases and high mortality; thus bacteraemia of dental origin can implicate severe complications with systemic manifestations; however there is still little evidence of antibiotic prophylaxis having a role in IE prevention. Both authors agree that individuals with no history of IE and are not medically compromised or susceptible have the same risk of developing IE with normal daily activities such as chewing due to the microbiota present in the oral cavity. Both authors go on to disclose the current American Heart Association guidelines for recommendation of pre-medication for those susceptible and at high risk and both authors agree with the AHA’s description of those candidates, although in both literature they concluded that there is not enough evidence to determine its efficacy in prevention of IE through the use of antibiotic prophylaxis and resistance is a major concern in the indiscriminate use of antibiotics in dentistry. Emphasis on establishing and maintaining the best possible oral hygiene is the most important factor in reducing the incidence and risk of IE. Furthermore, my article stated, “…more research is needed on the dynamics and inter-microbial mechanisms within oral biofilms to elucidate the pathogenic mechanisms involved in IE…development of novel approaches for targeted microbial control.” References Bascones-Martínez, A., Muñoz-Corcuera, M., & Meurman, J. (2009). Odontogenic infections in the etiology of infective endocarditis. //Cardiovascular & Hematological Disorders Drug Targets//, //9//(4), 231-235. Arlene C. Sides

Richey R., Stokes T., & Wray D. (2008). Prophylaxis against infective endocarditis: summary of  NICE guidance. // British Medical Journal, 336 (7647). // Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2287232/ It is recommended that patients with acquired valvular heart disease with stenosis or regurgitation, value replacement, structural congenital heart disease, previous infective endocarditis, and hypertrophic cardiomyopathy take a prophylaxis before dental treatments. The concern is that microorganisms from the oral cavity will travel to the heart and inhabit the damaged area. Our major concern with these patients should be good oral hygiene habits because they need to try and keep the bacteria in their mouth to a minimum to reduce the chance of IE. Velinda Davis #24

--- According to Carranza states that there is no current evidence that indicates prophylactic antibiotics will prevent late prosthetic joint infections. The ADA, American Academy of Orthopedic Surgeons, the American Academy of Oral Medicine and British Society for antimicrobial Chemotherapy all agree that routine antibiotic prophylaxis is not needed for most patient with prosthetic joint replacements. Although there are some high risk patients that are indicated like patient that have had a prosthetic replacement within the last 2 years, previous joint replacements, immunosupression, rheumatoid arthritis, SLE, type 1 DM, hemophilia, and the malnourished (664).

The article states that there is not enough evidence to conclude the antibiotic prophylaxis can decrease the chance of infection in areas where a pt has had prosthetic joint replacement. There is evidence that daily tooth brushing can introduce bacteria to the blood but yet there is no need to premedicate every time an individual brushes their teeth.

Benoit, G., & Pickett, F. (2011). Antibiotic prophylaxis with prosthetic joint replacement. What is the evidence?. //Canadian Journal Of Dental Hygiene//, //45//(2), 103-108. -Ashley Yanez



Carmona,G., Dios P, Scully Efficacy of Antibiotic Prophylactic Regiments for the Prevention of Bacterial Endocarditis of Oral Origin. Journal of Dental Research. December 2007;86(12):1142-1159. Available from:Dentistry & Oral Sciences Source, Ipswich, MA. Accessed February 26,

The big idea: This article discussed the importance of prophylactic pre-medication prior to dental procedure when the patients are at risk for bacterial endocarditis. The article focused of the use of Amoxicillian (or penicillian based antibiotics) to prevent bacterial endocarditis. The article further discusses the organisms involved in bacterial endocarditis, the portal of entry and destruction, the pathogenic, and antibiotic prophylaxis protocols and guidelines.

When researching antibiotic prophylaxis in the prevention of bacteria endocarditis in Carranza, the article supports the text. However, Caranzza goes further into detail discussing different antibiotics patients can take (such as clindamyacin for patients that are allergic to penicillin based antibiotics). According to Carranza, there is no distinction of effectiveness when comparing penicillin based antibiotics to Clyndamyicin as a prophylactic antibitiotic to prevent bacterial endocarditis. (Carranza, p. 655-657.)

-Kimberley Robinson#32

Seymour, R. R., Lowry, R. R., Whitworth, J. J., & Martin, M. M. (2000). Infective endocarditis, dentistry and antibiotic prophylaxis; time for a rethink?. British Dental Journal, 189(11), 610.

Both Carranza and my article discuss what endocarditis is, and who is at risk of developing Infective endocarditis. They also discuss the importance of oral hygiene and pre-procedural oral rinses prior to dental treatment to decrease the number of microorganisms. However, the article I chose does go into greater detail about concerns with the misuse of antibiotics and states that spontaneous bacteremia is more likely to cause infective endocarditis in at risk patients than dental treatments.

-Charlene Malit #29

Lam, D., Jan, A., Sandor, G., & Clokie, C. (2008). Prevention of infective endocarditis: revised guidelines from the American Heart Association and the implications for dentist. //Journal (Canadian Dental Association),// 74(5), 449-453

The article I read basically states that the revised guidelines were changed because it was shown that the risk of getting infective endocarditis was low and that it was only needed in high risk individuals. The overall conclusion was that no matter how much we can weigh out the pros and cons of prophylactic antibiotics, because there have been no trials done, there is no real answer and is unclear how effective prophylactic antibiotics can be.

When reading Carranza in regards to infective endocarditis it seemed like it was along the same lines that high risk patients still need to be given prophylactic antibiotics. The book mentioned that bacteremia can even still without having a dental procedure done, or in people who have bad oral hygiene and periodontal disease. The main idea was that as a clinician we should try to prevent the periodontal disease so that we can reduce patient’s risk of getting infective endocarditis.

Shanae Funiestas #25