Antibiotic Prophylaxis In Dental Procedures

Antibiotic Prophylaxis In Dental Procedures

Write Short Note On Antibiotic Prophylaxis In Dental Procedures.
Answer:

Antimicrobial prophylaxis is done for two distinct purposes viz.

Antibiotic Prophylaxis In Dental Procedures

• Prevention of dental wound infection, and
• Prevention of distant infection (Example. Bacterial endocarditis) in predisposed patients following dental procedures.

Prophylaxis Of Dental Wound Infection

Prophylaxis In Dental

• Wound infection occurs due to microbial contamination of the surgical site. It is important for the dental surgeon to see that the wound left after tooth extraction, etc. does not get infected.
• Use of sterile instruments, cross-infection control measures (antiseptic/disinfectant, etc.), and good surgical technique to minimize tissue damage, hematoma, and devascularization are the primary, and often the only measures needed. In addition, systemic antimicrobial prophylaxis is advocated in selected situations.
• Prophylaxis should be employed only when there is a clear risk of wound infection that outweighs the possible drawbacks of antibiotic use. In general, antibiotic prophylaxis is not required for routine dental surgery, except in patients at special risk.
• Simple extractions and minor periodontal procedures in otherwise healthy subjects are associated with a very low risk of wound infection.
• The incidence of postoperative infection is quite low even after difficult surgery such as removal of the impacted third molar, and antimicrobial prophylaxis is not required. However, it may be given when surgery involves extensive instrumentation, bone cutting is prolonged.
• Prophylaxis should also be given for procedures in which a prosthesis is inserted into the bone or soft tissue, such as dental implants.
• Extensive reconstructive surgery of the upper or lower jaw also warrants antibiotic prophylaxis.
• All orodental procedures which disturb/damage mucosa including extractions, scaling, etc. need to be covered by prophylaxis in diabetics, corticosteroid recipients, and other immunocompromised subjects.
• When the surgery has been performed in the presence of local infection, a continuation of the prophylactic antimicrobials beyond 4 hours after the dental procedure may be justified.
• In case of prolonged dental surgery, the antibiotic may be repeated IV during the procedure.
• Amoxycillin is the first choice of drug for prophylaxis.

Prevention Of Distant Infection or Prevention Of Infectious Disease

• Injury to a mucosa that is laden with bacteria introduces some of the bacteria into the bloodstream.
• Transient bacteremia occurs regularly during dental extraction, scaling, intraligamentary local anesthetic injection, root canal treatment, placement of a dental implant, or any other procedure in which the gingival margin is manipulated. The blood-borne bacteria can cause life—threatening endocarditis in subjects with posttraumatic or congenital endocardial abnormalities such as mitral stenosis and other valvular defects, artificial heart valves, or previous history of bacterial endocarditis. It is imperative that in above mentioned oriental procedures antibiotic prophylaxis is necessary in susceptible individuals.
• Antiseptic rinse with chlorhexidine (0.2%) held in the mouth for l minute just before dental treatment has been advocated as an adjuvant measure because it has been shown to reduce the severity of bacteremia following dental extraction.