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Fast Facts - Medically Compromised Patients & Antibiotics

Fast Facts

Fast Facts: Perio Edition Episode 31

[Andrew Johnston, RDH]
Welcome back,  everyone. You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
[Katrina Sanders, RDH]
Hello and welcome back to the conversation around medically compromised patients, prosthetic, joint infections and antibiotics. This week we are looking at the 2017 guidelines from JADA, offering guidance for the American Academy of Orthopedic Surgeons. Now, while we understand that there has been an incredible evolution in the utilization of prophylactic antibiotics prior to dental procedures, we also understand that not all patients present with the same physiologic conditions. Of note, JADA notated in their 2017 article that patients that are medically compromised or present with immunocompromising diseases may in fact require premedication, particularly if they have a prosthetic joint.
These could be patients, for example, who present with rheumatoid arthritis are on chronic steroids, immunosuppressants or have some sort of a malignancy. In addition, there were specific risk factors that were notated for the orthopedic surgery community. These were things like, is the prosthetic joint experiencing wound drainage, hematoma, any type of a post-operative infection? Was there a prior operation on that joint in which there was some type of an infection, or is the patient considered an uncontrolled diabetic patient?
In addition, there have been many inquiries for the ADA with regards to antibiotic prophylaxis for patients who have undergone other types of surgical interventions. It is worth it to notate that some patients, for example, beyond artificial joint replacement, may also require premedication. These could be patients, for example, that have received a solid organ transplant, a breast augmentation with implants or a penile implant. Additionally, the National Institute of Dental and Craniofacial Research recommends that in patients receiving chemotherapy in which there is a central venous catheter, that consultation should be performed with the treating oncologist about the need for antibiotic prophylaxis prior to proceeding with any dental procedures. Other considerations, patients that have a history of IV drug abuse in which there may be a risk of valve damage. A patient who has a history of taking Fen-phen in which there could be a valve damage, arteriovenous shunts, tunneled catheter, these types of ports or indwelling catheters could also be individuals who may require a premedication prior to dental procedures. And of course, any time that a patient presents with decreased white blood cell count, particularly from chemotherapy or some type of an immunosuppressive drug. This is a patient who may warrant a consultation with the treating physician to inquire about potential premedication guidelines.
Thank you for joining this week as we discussed premedication guidelines as they relate to the medically compromised patient. Stay tuned for next week as we unpack more details around premedication guidelines. Have a wonderful week.
This has been another episode of Fast Facts - Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website Cheers.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at We'll see you next week for another Fast Fact!

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