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אנטיביוטיקה פרופילקטית למניעת זיהומי מפרקים מלאכותיים אורתופדיים בעקבות טיפול שיניים
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אנטיביוטיקה פרופילקטית למניעת זיהומי מפרקים מלאכותיים אורתופדיים בעקבות טיפול שיניים

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Antibiotic Prophylaxis Prior To Dental Procedures For The Prevention Of Prosthetic Joint Infections …

Antibiotic Prophylaxis Prior To Dental Procedures For The Prevention Of Prosthetic Joint Infections
האם יש קשר בין טיפולי שיניים וזיהומים במפרקים אורתופדיים מלאכותיים? האם יש צורך במתן אנטיביוטיקה לפני טיפולי שיניים בחולים שעברו השתלת מפרק אורתופדי? מהם המינונים המומלצים? מהן ההמלצות למטופל?

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  • 1. Antibiotic Prophylaxis Prior To Dental Procedures For The Prevention Of Prosthetic Joint InfectionsVolfin Guy, Yarom Noam, Elad Sharon, Volpin Gershon1
  • 2. Volfin Guy, Yarom Noam, Elad Sharon, Volpin Gershon The Journal of the Israeli Dental Association .Apr;28(2):35-45, 74. Review. Hebrew 2011 Pub-Med indexed4
  • 3. Oral health & our body• poor oral health (e.g. gum inflammation & teeth decay) has a direct connection to a variety of body illnesses Endocarditis Diabetes CVS diseases Cancer & CHDs Mellitus Pregnancy CVA RF5 …and more
  • 4. J.E. Gegenral diagnosis •68 years old, male •Usually healthy •Bone malignant tumor 1999, right femur •Radiation + chemo + prosthetic joint6
  • 5. J.E. Dental condition •Teeth extracted •Teeth decay •Periodontal disease •Bone loss7
  • 6. Oral health & orthopedics? No recommendations yet from Israeli ministry of health8
  • 7. Oral health & orthopedics?AAOS Information Statement: Antibiotic Prophylaxis forBacteremia in Patients with Joint ReplacementsAAOM Position Paper:The Dental Treatment Of Patients With Joint Replacements9
  • 8. Oral health & orthopedics? AAOS and AAOM do NOT fully agree…10
  • 9. Oral health & orthopedics? “…The ADA and AAOS do not have a joint recommendation at this time. There are differing opinions on the need for antibiotic prophylaxis.”11
  • 10. Oral health & orthopedics? Poor oral health leads to Prosthetic Joint Infection (PJI) ?12
  • 11. Oral health & orthopedics? Dental procedures cause PJI ?Will Antibiotic Prophylaxis help? Which Antibiotics? How much?13
  • 12. Oral health & orthopedics? Good oral health + Dental procedures cause PJI ? Do you still need Antibiotic Prophylaxis ?14
  • 13. Oral health & orthopedics? Good oral health and PJI ?15
  • 14. Oral health & orthopedics?• Should the orthopedic surgeon & the dentist consult each other?• Should the orthopedic surgeon talk about oral health with the patient?16
  • 15. What’s in consensus? •1,000,000 total joint arthroplasties performed annually •7 percent are revision procedures17
  • 16. What’s in consensus?Prosthetic joint infection (PJI):• a severe illness• painful and discomforting• damages the quality of life• might be life-threatening18
  • 17. What’s in consensus? • Staphylococcus Epidermidis & Staphylococcus Aureus are the common bacteria in PJI • Staph. family are very rare inside the mouth19
  • 18. What’s in consensus? • Streptococci Viridans is common to the mouth (teeth decay, gum diseases) • A relatively much lower percentage of PJIs are caused by Streptococci Viridans20
  • 19. What’s in consensus?• Antibiotic prophylaxis is advisable where a risk of severe infective complications exists.21
  • 20. What’s in consensus? Antibiotic Toxicity Antibiotic Allergy prophylaxis Microbial Resistance22
  • 21. What’s in consensus?• With gum disease, even tooth brushing, eating etc. causes chronic bacteremia23
  • 22. What’s in consensus? • Both orthopedics surgeons and dentists should consider the possibility of PJI, consult each other and inform their patients • There is not enough knowledge up to date24
  • 23. What’s in consensus?• Some dental treatments might cause bacteremia25
  • 24. What’s NOT in consensus?• ALL patients with prosthetic joints should be considered candidates for PJI , therefore consider AP when undergoing dental procedures• That’s a life-time risk26
  • 25. What’s NOT in consensus?• Is the mouth the source for the PJIs reported?• Are ALL prosthetic joints are prone for PJI after a dental treatment?• Is this for life? Is this for each dental procedure?• Is antibiotic prohylaxis always recommendend before each dental treatment?27
  • 26. What’s NOT in consensus?• Some dental treatments might cause bacteremia, BUT NOT ALL• Prosthetic Joint Infections are RARELY caused by bacterial species common to the mouth• Evidence of a relationship between dental procedures and PJIs is CIRCUMSTANTIAL 28
  • 27. American Dental Association • ADA + AHA joint paper (2007): – dentists should reduce AP for prevention of Endocarditis by 90% (compared to previous recommendations) – widespread use of antibiotics = a significant increase of drug-resistant bacterial infections29
  • 28. American Dental Association • ADA + AHA joint paper (2007): – Daily bacteremia is even caused when brushing, eating etc.30
  • 29. Conclusions to g i ?ant ve or no ibiot t ic pr to give op h y l a xi s31
  • 30. Conclusions High risk patients & High risk dental Procedures (bacteremia) Antibiotic Prophylaxis Antibiotic Prophylaxis Maintain good Maintain good 1h before 1h before oral health oral health dental procedure dental procedure32
  • 31. I. High Risk of Prosthetic Joint Infection *• Immunocompromised / immunosuppressed• Inflammatory arthropathies (rheumatoid arthritis, SLE etc.)• Previous PJIs• less than 2 years after the prosthetic joint replacement• co-morbidities (e.g.: diabetes, obesity, HIV, smoking, Malnourishment, Hemophilia, Malignancy etc.)• poor oral health (e.g.: periodontitis, gingivitis, abscesses, osteomyelitis etc.)33 * Volfin G et al: The use of antibiotic prophylaxis prior to dental procedures for the prevention of prosthetic joint infection: Refuat Hapeh Vehashinayim. 2011 Apr;28(2):35-45, 74. Review. Hebrew. Pub-med indexed
  • 32. II. Dental procedures with HIGH risk for prosthetic joint Infection *• ALL PROCEDURES THAT DAMAGE THE ORAL TISSUES, CAUSING BLEEDING & BACTEREMIA34 * Based on the ADA Report, Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 2003;134(7):895-898
  • 33. Give antibiotic prophylaxis ? •Dental fillings •Dental crowns •Porcelain laminates •X-rays, dental CT35
  • 34. Give antibiotic prophylaxis ? •Root canal treatments •Orthodontic treatment •Dental anesthesia Only if Periodontal Ligament (PDL) is damaged36
  • 35. Give antibiotic prophylaxis ? Surgery: •Extractions •Dental implants, Bone implantations •Sinus lift •Stitches removal37
  • 36. Give antibiotic prophylaxis ? Periodontal disease / inflammation Periodontal treatment38
  • 37. Give antibiotic prophylaxis ? Periodontal Abscess drainage39
  • 38. Give antibiotic prophylaxis ?40
  • 39. III. Antibiotic Prophylaxis * Only if prescribed, only for high risk patients, to swallow (PO) 1 hour before high risk dental procedures Penicillin 2 gr Amoxicillin, Ampicillin Cephalosporins Cephalexin , Cefadroxil 2 gr * Not safe for severe penicillin allergy41
  • 40. III. Antibiotic Prophylaxis * Only if prescribed, only for high risk patients, to swallow (PO) 1 hour before high risk dental procedures Lincosamides Clindamycin / Dalacin C 600 mg * pregnant=ok, breast-feeding = not safe Macrolides 500 mg Azithromycin, Clarithromycin42 * Based on the ADA Report, Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 2003;134(7):895-898
  • 41. IV. Recommendations for orthopedics *• Inform Inform the patient & dentist before elective joint replacement that poor oral health is a possible risk for PJI.43 * Volfin G et al: The use of antibiotic prophylaxis prior to dental procedures for the prevention of prosthetic joint infection: Refuat Hapeh Vehashinayim. 2011 Apr;28(2):35-45, 74. Review. Hebrew. Pub-med indexed
  • 42. IV. Recommendations for orthopedics *• Refer Refer your patient to the dental surgeon before joint surgery44 * Volfin G et al: The use of antibiotic prophylaxis prior to dental procedures for the prevention of prosthetic joint infection: Refuat Hapeh Vehashinayim. 2011 Apr;28(2):35-45, 74. Review. Hebrew. Pub-med indexed
  • 43. IV. Recommendations for orthopedics *• Postpone postpone any elective joint replacement until completing necessary dental procedures even for a few weeks or months45 * Volfin G et al: The use of antibiotic prophylaxis prior to dental procedures for the prevention of prosthetic joint infection: Refuat Hapeh Vehashinayim. 2011 Apr;28(2):35-45, 74. Review. Hebrew. Pub-med indexed
  • 44. IV. Recommendations for orthopedics *• Add in your discharge summary: In each future dental treatment, the dentist should consider AP in order to prevent LPJI46 * Volfin G et al: The use of antibiotic prophylaxis prior to dental procedures for the prevention of prosthetic joint infection: Refuat Hapeh Vehashinayim. 2011 Apr;28(2):35-45, 74. Review. Hebrew. Pub-med indexed
  • 45. IV. Recommendations for orthopedics *• Recommend your patients: – regular visits in the dental clinic every 3 months – dental and gingival maintenance (home & clinic) – treat immediately any sign of infection47 * Volfin G et al: The use of antibiotic prophylaxis prior to dental procedures for the prevention of prosthetic joint infection: Refuat Hapeh Vehashinayim. 2011 Apr;28(2):35-45, 74. Review. Hebrew. Pub-med indexed
  • 46. J.E. •Never received antibiotic prophylaxis prior to dental treatment… •Was never informed by the dentist or by the orthopedic surgeon of any possible connection… Excu Excus se e …In me for …Inf me for n formi ormin no ng yo ot g you t u48
  • 47. J.E. Current status •2 gr. Moxypen po 1h before dental bacteremia •Periodontal maintenance every 3 months •Extractions + dental implants + bone implants •Crowns + root canals + fillings •Perfect OH49
  • 48. Lets work together … Orthopedic Dental Prevention of Surgeon Surgeon Prosthetic Joint Infection50
  • 49. Lets work together … our or Y ks F ion !Than ent Att dr.guy.volfin @ gmail . com www.dr-guy.com

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