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Dental Aspects of Endocarditis Prophylaxis |
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[α] no data but the procedure is very similar to that of gingival retraction cord placement [β] no data but the procedure is similar to pulpotomy of a primary molar [γ] the avulsed tooth can be quickly washed and re-implanted immediately by a parent or other responsible person and the antibiotic prophylaxis administered when a child attends the dental surgery provided this is within 2 hours of the reimplantation. This is because antibiotic prophylaxis is still successful if administered after the bacteraemic episode. [δ] it is common for a course of dental treatment to take place over several visits to the dentist. For patients at high or moderate risk of developing infective endocarditis as much treatment as possible should be carried out at each visit. The antibiotic should be changed at alternate visits—Amoxicillin— Clindamycin—Amoxicillin and so on. For young children the sequence would be Amoxicillin—Azithromycin—Amoxicillin and so on. If penicillin or penicillin related antibiotics are used as one of the antibiotics then a period of 1 month must be allowed between visits when a penicillin antibiotic is used. Dentists can help further by planning dental care to minimize the number of times that patients are exposed to antibiotics by carrying out as much treatment as is feasible at each visit. In an emergency when treatment needs to be carried out urgently the dental surgeon should make an assessment as to whether or not the patient is significantly at risk from IE. If the answer is affirmative, the patient’s clinical records should then be marked appropriately and consideration given to the risk of bacteraemia associated with the dental procedures to be carried out on the patient. If there is a risk of a significant bacteraemia then antibiotic prophylaxis should be given.
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Dental procedures and endocarditis prophylaxis for high and moderate at-risk cases. |
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Regime for LA & Sedation/GA |
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RECOMMENDED FOR ANTIBIOTIC PROPHYLAXIS |
NOT RECOMMENDED FOR ANTIBIOTIC PROPHYLAXIS |
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Examination Procedures |
Examination Procedures |
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Periodontal probing |
Dental examination with mirror & probe |
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Investigation Procedures |
Investigation Procedures |
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Sialography |
Intra-oral radiographs |
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Extra-oral radiographs |
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Preventive procedures |
Preventive procedures |
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Fissure sealants |
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Fluoride treatments |
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Professional Cleaning Procedures |
Professional Cleaning Procedures |
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Polishing teeth with a Rubber Cup |
Air polishing |
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Oral irrigation with water jet |
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Light scaling |
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Deep scaling |
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Scaling teeth with hand instrument |
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Scaling with ultrasonic instrument |
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Anaesthetic Procedures |
Anaesthetic Procedures |
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Intraligamental local anaesthesia |
Infiltration local anaesthesia |
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Nerve block local anaesthesia |
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Oral airway for GA |
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Nasal airway for GA |
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Laryngeal mask airway for GA |
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Comprehensive Dental Treatment under General Anaesthesia |
Comprehensive Dental Treatment under General Anaesthesia |
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Extractions and fillings |
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Conservative (Restorative) Procedures [δ] |
Conservative (Restorative) Procedures |
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Rubber dam placement |
Slow & Fast drilling of teeth (without rubber dam) |
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Matrix band and wedge placement |
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Gingival retraction cord placement |
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Periodontal Procedures |
Periodontal Procedures |
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Root planning |
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Antibiotic fibres or strips placed subgingivally [α] |
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Gingivectomy |
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Periodontal Surgery |
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Endodontic Procedures |
Endodontic Procedures |
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Root canal instrumentation beyond the root apex |
Root canal instrumentation within canal |
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Avulsed tooth reimplantation [γ] |
Pulpotomy of primary molar |
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Pulpotomy of permanent tooth [β] |
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Orthodontic Procedures |
Orthodontic Procedures |
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Tooth separation |
Alginate impresssions |
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Expose or Expose & Bond of tooth/teeth |
Band placement and cementation |
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Band removal |
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Adjustment of fixed appliances |
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Surgical Procedures |
Surgical Procedures |
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Extraction of a single tooth |
Incision and drainage of an abscess |
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Extraction of multiple teeth |
Biopsy |
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Mucoperiosteal flap to gain access to tooth or lesion |
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Dental Implants |
Dental Implants Transmucosal fixture (as for biopsy) |
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Post Surgical Procedures |
Post Surgical Procedures |
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Suture removal |
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Removal of surgical packs |
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Other Events |
Other Events |
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Antibiotic prophylaxis not recommended as it is impractical despite presence of bacteraemia following some of these events. This is largely because of the significant risk of development of bacteria resistant to the antibiotics used. |
Toothbrushing |
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Exfoliation of primary teeth |