Certain populations of dental patients are at risk of developing systemic infections as a consequence of transient bacteremias associated with various dental procedures. Given today's medical-legal environment, the dentist must have a basic understanding of the ever-changing issue of antimicrobial prophylaxis.

Upon completion of this course, participants should be able to do the following:

1. Understand the most current AHA guidelines for antimicrobial prophylaxis and when to implement them in practice.
2. Understand the antimicrobial prophylaxis guidelines for the total joint replacement patient and when to implement them in practice.
3. Understand that there are a variety of medically complex patients who may be considered for antimicrobial prophylaxis and may require consultation with a physician in order to determine the prophylaxis need.

Certain populations of dental patients are at risk of developing systemic infections as a consequence of transient bacteremias associated with various dental procedures. Given today's medical-legal environment, the dentist must have a basic understanding of the ever-changing issue of antimicrobial prophylaxis. The foundation on which antimicrobial prophylaxis is endorsed is based on in vitro studies and empirical or anecdotal experience. The most frequently encountered example of a patient requiring antimicrobial prophylaxis prior to dental treatment is the patient with a rheumatic heart murmur or other pathologic heart problems. The American Heart Association has published specific guidelines for managing these patients. Other patients for whom antimicrobial prophylaxis should be considered include the asplenic patient, the neutropenic patient, the uncontrolled diabetic, end-stage renal disease cases, in cases of transplant and the total joint replacement patient. Unfortunately, universally accepted guidelines for all these patients are not available. New guidelines are available for the Total Joint Replacement Patient.

COURSE OUTLINE

1. Cardiac Conditions Associated with Bacterial Endocarditis
   
   
   
   1. High-Risk Categories
      
      
      
      1. Prosthetic Valves
         
         
      2. Previous History of Bacterial Endocarditis
         
         
      3. Complex Cyanotic Congenital Heart Disease
         
         
      4. Surgically Constructed Systemic Pulmonary Shunts or Condiuts
      
      
   2. Moderate-Risk Categories
      
      
      
      1. Other Congenital Defects
         
         
      2. Acquired Valvular Dysfunction - Rheumatic Heart Disease
         
         
      3. Mitral Valve Prolapse
         
         
      4. Hypertrophic Cardiomyopathy
      
      
   3. Other Considerations for Antimicrobial Prophylaxis
      
      
      
      1. Murmurs
         
         
      2. Systemic Lupus Erythematosus Patient
         
         
      3. Marfan"s Syndrome
         
         
      4. Neutripenic Patient
         
         
      5. Diabetic Patient
         
         
      6. Asplenic Patient
         
         
      7. End Stage Renal Disease Patient
         
         
      8. Transplant Patient
         
         
      9. Total Joint Replacement Patient
      
      
   4. Patient's Responsibility
      
      
   5. Summary
      
   
   

1. Dajani AS, Taubert KA, Wilson W, Bolger AF et al. Prevention of Bacterial Endocarditis. JAMA. 1997; 277 (22): 1794 - 1801.
2. American Dental Association. American Academy of Orthopaedic Surgeons Advisory Statement: Antibiotic prophylaxis for dental patients with total joint replacements. JADA. 1997; 128: 1004 - 1008.
3. Bricker SL, Langlais RP, Miller CS. Oral Diagnosis, Oral Medicine, and Treatment Planning. 2nd ed. Philadelphia, PA: Lea and Febiger; 1994.
4. Little JW, Falace DA. Dental Management of the Medically Compromised Patient. 4th ed. St Louis, Missouri: Mosby; 1993