Prophylaxis

The dental practice can transmit infections through oral procedures that cause bleeding, allowing microorganisms and their products to enter the bloodstream. This can lead to systemic effects and contribute to diseases such as endocarditis, joint infections, and abscesses. Conditions such as HIV, immunodeficiencies, and poorly controlled diabetes can increase the risk of infection in individuals with compromised immune systems.

The use of antimicrobials is indicated.

The frequency of transient bacteremias induced by treatments and self-induced.

Dental office

Intraligamentary anesthesia injections in children: 16 to 97%

Periodontal surgery: 36 to 88%

Daily routine

Chewing: 17 to 51%

Flossing: 0 to 58%

New perspective

In the future, it is essential to increase non-antibiotic preventive methods for infective endocarditis and decrease antibiotic use based on recommendations and guidelines with a narrowed focus on the procedure and the type of patient candidate for antimicrobial prophylaxis, reducing the use of prophylactic antibiotics without exposing the patient to disseminated infections.

Indications

Every treatment that involves manipulation of the gingival tissue or periapical region of the tooth or perforation of the oral mucosa. Imperative whenever bleeding is anticipated.

If there is already a latent infection, antibiotic premedication will be opted for at least 30 minutes before the procedure and continue with conventional antibiotic therapy.

In dentoalveolar traumas requiring manipulation of hard or soft tissues

Contraindications

Dental operations using atraumatic staples for placement of sealants or fissurotomies include:

  • Impression taking
  • Placement of temporary restorations
  • Fluoride application
  • Preparation for fixed prostheses (inlays and onlays)
  • Placement, adjustment, or removal of orthodontic attachments
  • Placement of removable prostheses
  • Root canal treatment where the cemento-dentinal junction is not exceeded
  • Radiographic imaging
  • Suture removal
  • Exfoliation of primary teeth
  • Placement of endodontic posts

Perform mouthwash with chlorhexidine 0.2% or at least 0.12% at a rate of 10 mL for 1 minute before any dental manipulation, especially those involving bleeding

Base on the guidelines AHA, ESC, BSAC, and CENETEC for cardiac conditions warranting antimicrobial prophylaxis.

Regina Sánchez Mercader
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