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Fast Facts – Premedication Changes

Fast Facts: Perio Edition Episode 32
[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 to Fast Facts: Perio Edition. This week, we are going to be stirring up, pun intended, a little bit of drama with regards to some of the things that we understand about premedication guidelines, particularly for heart infections. Now, I know what you’re all thinking, really, Ginger, this is what we’re doing this week. And I get it because we’ve had quite an evolution haven’t we of premedication guideline shifts over the past decade or so.
However, published most recently in Circulation Journal, the American Heart Association on April 15th, published about the fact that preventing heart infections by oral bacteria, while we thought was better done with antibiotics, could also be due in turn to optimized oral wellness. You see, for a long time we looked at, you know, various types of patients that would benefit from antibiotic prophylaxis, according to the American Heart Association, and for the most part, those were typically patients that had heart conditions that may predispose them to infective endocarditis, as well as, of course, those who have a prosthetic joint and may be at risk for developing some type of an infection at the site of prosthetic.
These guidelines were instituted in 2007 and then, of course, approved for dentistry in 2008. But as we’ve continued to see research unpacking some of the risks associated with utilizing antibiotics before a dental procedure, we’ve actually found that there are incredible risks associated with overuse of antibiotics in our patient population. In fact, what we found was that in 2007, when the American Heart Association guidelines changed a great number of patients who would have been placed on antibiotic prophylactic prophylaxis before a dental procedure, about 90 percent of those patients were no longer being premedicated.
And we began to find that, although a vast majority of those individuals were now no longer receiving antibiotics, we actually were not seeing an increased number of cases of endocarditis. So we do believe that although, yes, patients that have prosthetic cardiac valves, prosthetic material, previous relapse or recurrent infective endocarditis, congenital heart disease or cardiac transplant recipients are all going to be appropriate subsets of our patients that are going to benefit from prophylaxis antibiotics prior to dental procedures in which there’s manipulation of the gingiva. We’ve found that several other populations of patients that had been previously placed on antibiotics no longer need this.
In fact, the guidelines note that people who are at risk for infective endocarditis are actually regularly exposed to oral bacteria during activities like brushing or flossing. And so the statement remains. Optimal oral health is maintained through regular professional dental care and the use of appropriate dental products, such as manual, powered and ultrasonic toothbrushes, dental floss and other plaque removal devices. Suffice it to say, new research from the American Heart Association is encouraging optimal oral health as a key component to reducing the risk of infective endocarditis and may play a more profound role than the concerns of bacterial seeding and subsequent utilization of antibiotics prophylactically before dental procedures.
That has been Fast Facts this week as we take a look at prophylactic antibiotics for the reduction of potential infective endocarditis. 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 www.KatrinaSanders.com 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 www.dentistrx.com. We’ll see you next week for another Fast Fact!

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