EVIDENCE BASED MEDICINE
Revised precaution criteria against infective endocarditis in dental operations.
During the 20th century, scientists, based on the fact that during operational procedures “transient” bacteraemia is caused, and therefore, the risk of infective endocarditis is increased, proposed a preventive antibiotic treatment in a wide range of patients with predisposing factors. However, as it has been later proved, bacteraemia does not only occur during dental operations but also during chewing or tooth brushing, however it is of low virulence < 1-100 colonies/ml of blood and of short duration < 10min, and thus has no considerable clinical significance. Classical pathogenic micro-organisms that are implicated in Infective Endocarditis are Streptococci, Enterococci, Staphyloccoci, gram (-), bacilli of the Hacek group and intracellular bacteria. The above bacteria have surface proteins that have the capacity to be deposited and colonize heart valves. According to the revised criteria of ΑΗΑ and ESC that have been published in 2009 the wide use of preventive antibiotic treatment is no longer supported, but a limited precaution treatment is recommended in high-risk patients for the development of infective endocarditis. However, recent studies have shown that 1: 14,000,000 dental operations will lead to Infective Endocarditis, while, on the other hand, the large-scale use of antibiotics leads to the risk of anaphylactic reaction as well as the risk of generation of resistant microbes. Regarding dental operations, aseptic surgical conditions are mandatory, by principle, during these dental operations, while the good oral hygiene plays also a very important role.
Heart diseases with a high risk of development of infective endocarditis
1. Patients with prosthetic valve.
2. Patients with previous events of infective endocarditis.
3. Patients with congenital heart defects.
Chemoprevention is recommended: For operations in the area of gums and teeth or in oral mucosa perforation interventions. On the contrary, chemoprevention is not recommended for anesthesia injections to the gums, the removal of sutures or in orthodontic operations, nor for stapling in the area of the gums and the lips. Recommended preventive treatment for dental operations A SINGLE DOSE 30-60min BEFORE THE OPERATION
| ANTIBIOTIC TREATMENT | ADULTS | CHILDREN |
| Amoxicillin ή ampicillin | 2gr p.o or iv | 50mgr/kgr of Body Weight |
| Clindamycin (in cases of penicillin allergy) | 600mg p.o or i.v | 20mg/kgr p.o or iv |
Cephalosporins are not recommended to patients with penicillin allergy due to possible cross-reaction.