Antibiotic Prophylaxis Prior    To Dental Procedures For          The Prevention Of    Prosthetic Joint InfectionsVolfin G...
Volfin Guy, Yarom Noam, Elad Sharon, Volpin Gershon    The Journal of the Israeli Dental Association        .Apr;28(2):35-...
Oral health & our body• poor oral health (e.g. gum inflammation & teeth  decay) has a direct connection to a variety of bo...
J.E.    Gegenral diagnosis    •68 years old, male    •Usually healthy    •Bone malignant tumor 1999, right femur    •Radia...
J.E.    Dental condition    •Teeth extracted    •Teeth decay    •Periodontal disease    •Bone loss7
Oral health & orthopedics?    No recommendations yet from Israeli ministry of health8
Oral health & orthopedics?AAOS Information Statement: Antibiotic Prophylaxis forBacteremia in Patients with Joint Replacem...
Oral health & orthopedics?     AAOS and AAOM do NOT fully agree…10
Oral health & orthopedics?     “…The ADA and AAOS do not have a joint     recommendation at this time.     There are diffe...
Oral health & orthopedics? Poor oral health leads to Prosthetic Joint Infection (PJI) ?12
Oral health & orthopedics?                Dental procedures cause PJI ?Will Antibiotic Prophylaxis help? Which Antibiotics...
Oral health & orthopedics?     Good oral health + Dental procedures cause PJI ?          Do you still need Antibiotic Prop...
Oral health & orthopedics?         Good oral health and PJI ?15
Oral health & orthopedics?• Should the orthopedic  surgeon & the dentist  consult each other?• Should the orthopedic  surg...
What’s in consensus?     •1,000,000 total joint     arthroplasties performed     annually     •7 percent are revision     ...
What’s in consensus?Prosthetic joint infection (PJI):• a severe illness• painful and discomforting• damages the quality of...
What’s in consensus?     • Staphylococcus Epidermidis &       Staphylococcus Aureus are the       common bacteria in PJI  ...
What’s in consensus?     • Streptococci Viridans is common to       the mouth       (teeth decay, gum diseases)     • A re...
What’s in consensus?• Antibiotic prophylaxis is advisable where a risk of severe  infective complications exists.21
What’s in consensus?                                 Antibiotic Toxicity      Antibiotic                                 A...
What’s in consensus?• With gum disease, even tooth brushing, eating etc. causes  chronic bacteremia23
What’s in consensus?     • Both orthopedics surgeons and dentists should consider       the possibility of PJI, consult ea...
What’s in consensus?• Some dental treatments might  cause bacteremia25
What’s NOT in consensus?• ALL patients with prosthetic joints should be considered  candidates for PJI , therefore conside...
What’s NOT in consensus?• Is the mouth the source for the PJIs reported?• Are ALL prosthetic joints are prone for PJI afte...
What’s NOT in consensus?• Some dental treatments might cause  bacteremia, BUT NOT ALL• Prosthetic Joint Infections are RAR...
American Dental Association • ADA + AHA joint paper (2007):     – dentists should reduce AP for prevention of Endocarditis...
American Dental Association • ADA + AHA joint paper (2007):     – Daily bacteremia is even caused when brushing, eating   ...
Conclusions            to g                i           ?ant ve or no               ibiot     t                    ic pr to...
Conclusions                    High risk patients                             &                High risk dental Procedures...
I. High Risk of Prosthetic Joint Infection *• Immunocompromised / immunosuppressed• Inflammatory arthropathies (rheumatoid...
II. Dental procedures with HIGH risk for            prosthetic joint Infection *• ALL PROCEDURES THAT DAMAGE THE ORAL TISS...
Give antibiotic prophylaxis ?     •Dental fillings     •Dental crowns     •Porcelain laminates     •X-rays, dental CT35
Give antibiotic prophylaxis ?     •Root canal treatments     •Orthodontic treatment     •Dental anesthesia                ...
Give antibiotic prophylaxis ?     Surgery:     •Extractions     •Dental implants, Bone implantations     •Sinus lift     •...
Give antibiotic prophylaxis ?     Periodontal disease / inflammation     Periodontal treatment38
Give antibiotic prophylaxis ?     Periodontal Abscess drainage39
Give antibiotic prophylaxis ?40
III. Antibiotic Prophylaxis *          Only if prescribed, only for high risk patients,     to swallow (PO) 1 hour before ...
III. Antibiotic Prophylaxis *          Only if prescribed, only for high risk patients,     to swallow (PO) 1 hour before ...
IV. Recommendations for orthopedics *• Inform     Inform the patient & dentist     before elective joint replacement     t...
IV. Recommendations for orthopedics *• Refer     Refer your patient to the dental     surgeon before joint surgery44      ...
IV. Recommendations for orthopedics *• Postpone     postpone any elective joint     replacement until completing     neces...
IV. Recommendations for orthopedics *• Add in your discharge summary:     In each future dental treatment,     the dentist...
IV. Recommendations for orthopedics *• Recommend your patients:     – regular visits in the dental clinic       every 3 mo...
J.E.     •Never received antibiotic prophylaxis prior to     dental treatment…     •Was never informed by the dentist or b...
J.E.     Current status     •2 gr. Moxypen po 1h before dental bacteremia     •Periodontal maintenance every 3 months     ...
Lets work together … Orthopedic     Dental          Prevention of  Surgeon      Surgeon         Prosthetic Joint          ...
Lets work together …            our        or Y    ks F ion !Than ent   Att                   dr.guy.volfin @ gmail . com ...
אנטיביוטיקה פרופילקטית למניעת זיהומי מפרקים מלאכותיים אורתופדיים בעקבות טיפול שיניים
אנטיביוטיקה פרופילקטית למניעת זיהומי מפרקים מלאכותיים אורתופדיים בעקבות טיפול שיניים
Upcoming SlideShare
Loading in …5
×

אנטיביוטיקה פרופילקטית למניעת זיהומי מפרקים מלאכותיים אורתופדיים בעקבות טיפול שיניים

1,074 views

Published on

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?

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,074
On SlideShare
0
From Embeds
0
Number of Embeds
309
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

אנטיביוטיקה פרופילקטית למניעת זיהומי מפרקים מלאכותיים אורתופדיים בעקבות טיפול שיניים

  1. 1. Antibiotic Prophylaxis Prior To Dental Procedures For The Prevention Of Prosthetic Joint InfectionsVolfin Guy, Yarom Noam, Elad Sharon, Volpin Gershon1
  2. 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. 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. 4. J.E. Gegenral diagnosis •68 years old, male •Usually healthy •Bone malignant tumor 1999, right femur •Radiation + chemo + prosthetic joint6
  5. 5. J.E. Dental condition •Teeth extracted •Teeth decay •Periodontal disease •Bone loss7
  6. 6. Oral health & orthopedics? No recommendations yet from Israeli ministry of health8
  7. 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. 8. Oral health & orthopedics? AAOS and AAOM do NOT fully agree…10
  9. 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. 10. Oral health & orthopedics? Poor oral health leads to Prosthetic Joint Infection (PJI) ?12
  11. 11. Oral health & orthopedics? Dental procedures cause PJI ?Will Antibiotic Prophylaxis help? Which Antibiotics? How much?13
  12. 12. Oral health & orthopedics? Good oral health + Dental procedures cause PJI ? Do you still need Antibiotic Prophylaxis ?14
  13. 13. Oral health & orthopedics? Good oral health and PJI ?15
  14. 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. 15. What’s in consensus? •1,000,000 total joint arthroplasties performed annually •7 percent are revision procedures17
  16. 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. 17. What’s in consensus? • Staphylococcus Epidermidis & Staphylococcus Aureus are the common bacteria in PJI • Staph. family are very rare inside the mouth19
  18. 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. 19. What’s in consensus?• Antibiotic prophylaxis is advisable where a risk of severe infective complications exists.21
  20. 20. What’s in consensus? Antibiotic Toxicity Antibiotic Allergy prophylaxis Microbial Resistance22
  21. 21. What’s in consensus?• With gum disease, even tooth brushing, eating etc. causes chronic bacteremia23
  22. 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. 23. What’s in consensus?• Some dental treatments might cause bacteremia25
  24. 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. 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. 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. 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. 28. American Dental Association • ADA + AHA joint paper (2007): – Daily bacteremia is even caused when brushing, eating etc.30
  29. 29. Conclusions to g i ?ant ve or no ibiot t ic pr to give op h y l a xi s31
  30. 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. 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. 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. 33. Give antibiotic prophylaxis ? •Dental fillings •Dental crowns •Porcelain laminates •X-rays, dental CT35
  34. 34. Give antibiotic prophylaxis ? •Root canal treatments •Orthodontic treatment •Dental anesthesia Only if Periodontal Ligament (PDL) is damaged36
  35. 35. Give antibiotic prophylaxis ? Surgery: •Extractions •Dental implants, Bone implantations •Sinus lift •Stitches removal37
  36. 36. Give antibiotic prophylaxis ? Periodontal disease / inflammation Periodontal treatment38
  37. 37. Give antibiotic prophylaxis ? Periodontal Abscess drainage39
  38. 38. Give antibiotic prophylaxis ?40
  39. 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. 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. 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. 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. 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. 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. 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. 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. 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. 48. Lets work together … Orthopedic Dental Prevention of Surgeon Surgeon Prosthetic Joint Infection50
  49. 49. Lets work together … our or Y ks F ion !Than ent Att dr.guy.volfin @ gmail . com www.dr-guy.com

×