For more than 50 years, prophylaxis protocols for infective endocarditis have been in a process of continuous evolution.
WHAT IS INFECTIOUS ENDOCARDITIS?
The infective endocarditis or bacterial endocarditis It is an infrequent but potentially fatal infection of the lining of the heart chambers and valves by infectious agents, usually bacteria, although it can also be due to fungi and viruses, causing inflammation of the cardiac and valve endothelium.
Most people who develop this infection tend to have underlying heart disease, and despite advances in diagnosis, antimicrobial treatment, surgical techniques, and management of complications, patients with bacterial endocarditis continue to have substantial morbidity and mortality in relation to this condition.
RELATIONSHIP OF ENDOCARDITIS WITH DENTAL PROCEDURES
Transient bacteremia is common with manipulation of the teeth and periodontal tissues.
There is a wide variation in the reported frequencies of bacteremia as a result of dental procedures:
- Tooth extraction, between 10 and 100%
- Periodontal surgery, between 36 and 88%
- Scraping and root planing, between 8 and 80%
- Dental cleaning, up to 40%
- Placement of rubber dams and / or wedges, between 9 and 32%
- Endodontic procedures, up to 20%.
Transient bacteremia also occurs frequently during routine daily activities not related to a dental procedure:
- Tooth brushing and flossing (20-68%)
- Use of wooden chopsticks (29-40%)
- Use of aqueous irrigation devices (7-50%)
- Chew gum (7-51%)
Bacteria from the oral cavity can and do enter the bloodstream on many occasions, but only rarely infect the heart. It has been estimated that a normal citizen has an average of 5,376 minutes of transient bacteremia per month, due to daily activities of oral origin.
IN WHICH PATIENTS IS IT NECESSARY TO MAKE A PROPHYLAXIS OF ENDOCARDITIS?
Dental procedures for which the AHA (American Heart Association): American Heart Association) recommends endocarditis prophylaxis in patients with underlying cardiac conditions associated with an increased risk of an adverse prognosis in infectious endocarditis.
All dental procedures that involve manipulation of gingival tissue or the periapical region of the tooth or perforation of the oral mucosa. Except for: routine anesthetic injections through non-infected tissue, dental X-rays, placement of removable orthodontic or prosthodontic appliances, fitting of orthodontic appliances, placement of orthodontic braces, replacement of primary teeth, and bleeding from trauma to the lips or oral mucosa.
The patients at risk who should do endocarditis prophylaxis prior to the mentioned treatments are the following:
- Previous infective endocarditis
- Heart valve prosthesis
- Congenital heart disease
- Heart transplant recipients who develop valve disease
WHAT MEDICATION SHOULD BE TAKEN AND WHEN?
Bacterial prophylaxis of infective endocarditis is carried out by administering a high concentration antibiotic between half an hour and an hour before of dental treatment.
Standard general prophylaxis is based on taking amoxicillin orally, 2g for adults and 50mg / kg for children. In case of allergy to penicillin, the drug is changed to oral clindamycin, 600mg in adults and 20mg / kg in children.
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