Mrs. Susan Davis

Why do some Orthopedic surgeons recommend prophylactics for life for some patients with knee replacements ?

I wish there was a good answer for your question, Susan. Not all health care professionals are current with the latest guidelines. We wish they were!

J. F.

For premedication considerations. Do you recommend kidney transplants be premedicated?

Presently, there are no clinical guidelines for patients who had a kidney transplant. No antibiotic premedication is recommended at this time.

K. M.

Has it been proven that a pre rinse reduces the Covid 19 virus

At this time, there are laboratory studies being conducted to address preprocedural rinsing for the coronavirus. Stay tuned!

Dr. Jeffrey Schillinger

If a patient is currently taking an antimicrobial for an acute issue (prescribed by their M.D.), what's the protocol if they need to premedicate due to recent orthopedic replacements?

Let's take a step back. First, in most cases, the patient should not need to premedicate due to recent orthopedic replacement. There are very few circumstances in which they would need to premedicate. That being said, if there was a special circumstance, and premedication was warranted, and the patient was taking an antibiotic for a separate acute issue, follow the American Heart Association guidelines https://www.heart.org/-/media/data-import/downloadables/c/b/3/pe-pdf-chd-infectiveendocarditiswalletcard-ucm_307644.pdf?la=en

Miss Ashley Adkisson

How high of A1c should we consider abx for pre-medication? What if the patient isn’t aware of their A1c but is on 2 types of diabetic medicine.

Patients who have an elevated A1c are not indicated for pre-medication in an of itself. Patients with diabetes may be well managed with their diabetes medication. If the patient requires joint replacement, follow the American Academy of Orthopedic Surgeons Appropriate Use Criteria (refer to Ortho Guidelines) to determine if the patient truly requires antibiotic premedication.

K. D.

The local orthopod and I have a constant disagreement on premed prior to dental procedures. I have provided him the literature and he agrees, but still tells pts to premed for at least 2 years after a routine replacement. This puts me in an awkward position with patients. Any recommendations?

Yes! You are the licensed health care provider who makes the decisions about the care your patient needs. You can provide the orthopedist with a kind letter informing that individual of your decision about the care you will be providing based on current literature and clinical guidelines. Period.

R. G.

IS PEMED NECESSARY FOR A KIDNEY TRANSPLANT PATIENT

There are no clinical guidelines presently that indicate premedication is necessary for patients with a kidney transplant.

Miss ShannonRae Valdez

I call The cardiologist/ortho surgeon the day before for each and every premed pt (I say I believe it’s uneeded) and 9 X out of 10 they say take it. How do we educate surgeons on current standards??

Please remember that you are the licensed health care provider treating the patient. It is your decision to make, not the orthopedic surgeon. You can kindly provide a letter informing the orthopedic surgeon/cardiologist of your decision based on the literature and clinical guidelines. Period.

Dr. Joseph Wittig

Do you find orthopedic surgeons are the most resistant to adopt the newer guideline i.e. most patients with prosthetic joints do NOT need AB prophylaxis?

The American Academy of Orthopedic Surgeons have created Use Criteria that is very supportive of limited use of antibiotic premedication, so they are not all resistant to adopt newer guidelines. However, some are, just as we see that some dentists overprescribe antibiotics. We all need to be vigilant in our practices and use current guidelines and evidence to guide our decision making.

C. S.

Legally, is a dentist to require a pre-med recommendation from an MD, even if you know it's incorrect?

Legally, the dentist is the decision maker for the care the dentist provides.

Irene Verdream

What about kidney disease

This is a very generic statement. Antibiotics are not prescribed for patients with kidney transplants. Generally, antibiotics are not prescribed for patients undergoing dialysis unless they require incision and drainage for a dental abscess. No clinical guidelines are available for patients with these kidney diseases at this time.

R. G.

SHOULD HIV OR AIDS PATIENTS BE GIVEN PREMED

This would depend on their levels of infections (comorbidities), CD4 counts, etc.

Lynn Bergstrom Bryan

we have a large practice that asks that we premed women who have had breast implants...thoughts?

The potential benefit of antibiotic premedication does not outweigh the known risks of C.diff infection, allergy, drug interactions or antibiotic resistance.

R. G.

SO I'M TAKING IT THAT WE NO LONGER GIVE PREMED FOR PROSTHETIC JOINTS ..WHAT ABOUT IF THEY HAVE 2 OR MORE PROSTHETICS

The same principles apply. Follow the clinical guidelines.

Laila Bonner

How often are recommendations for prophylactic antibiotic for dental procedures updated; and, which year was the last one? Thanks

guidelines are monitored and updated as new research becomes available; the last one was published in 2015.

D. R.

since it is unethical to use patients as guinea pigs there is no proof of changing is going to really be beneficial and the actual proof will be when we do change the guidelines and after time and if it truly does or doesn't help

Retrospective studies are very informative.

C. E.

My concern with prophylactic antibiotics with heart valve and other conditions: isn’t it ultimately not our decision or call to make? I believe the one that should make the decision of putting a patient on antibiotic or not is the cardiac surgeon or doc not us. Same
With joint replacement ?

If you hold a license and provide health care services, you are the decision maker. You cannot defer as if you are incapable of making an informed decision.

S. S.

pls talk about tha antibiotics use in this corona lockdown period where its difficlt to carry out procedures and the dos and donts

That topic is beyond the scope of this course.

R. G.

IS NYS HYGIENIST GOING TO BE ABLE TO USE THEIR HYGIENE LICENCE IN ALL STATES,,,IF SO,,,WHEN

That topic is beyond the scope of this course.

R. G.

A PATIENT HAS A CARDIAC STENT,,HOW LONG AFTER THE SURGERY CAN WE NOT GIVE PREMED

Premedication is not needed for stents placed in coronary arteries.

T. W.

what if I get it wrong with proper protocol for ab antibiotics... I'm a dentist not a orthopedic surgeon.... will I be sued?

Always document your protocol and the clinical guidelines (or literature) that supported your decision.

Ms. MaryAnn Hugh

But..... I always refer back to the surgeon for the final judgement . Actually by phoning the surgeon's office to ask what their recommendation for this patient is.

While it is nice to have someone else's opinion, you are the licensed health care provider delivering care. You are the one responsible for making the decision based on clinical guidelines and evidence. It is not up to others to make this decision for you.

Tina Day

What about testicular implants

We do not have clinical guidelines for penile implants. The answer is a definite maybe. We wish we could be more specific. Consult the patient's surgeon and the latest literature.

Dr. Lam Vu

Hi Drs.,
I have a patient who has recurrent re-infected total knee replacement and is on year around abx Augmentin 500mg bid x 1 year. Does the patient needs ABX prophylaxis and what is the best prophylaxis abx for this patient? Sincerely thanks, Dr. Vu

This is a very difficulty situation for your patient. The patient will need to be prescribed an alternate antibiotic. Consult the American Heart Association for options.

R. G.

GOOD COURSE, VERY INFORMATIVE. THANK YOU TO BOTH OF YOU

Thank you for participating!

Mrs. Jeana Shroyer

Is the app supposed to bypass asking the orthopedic surgeon. Some of our local orthopedic surgeons want their patients to be premeditated prior to cleanings.

The app was created by the American Academy of Orthopedic Surgeons so you can use this instead of consulting the local doctor.

Mrs. Angela Castleman

Many of my patients have neck fusions, should they be premeditated?

Fusions should not require premedication.

K. D.

Please consult the laws in your state and contact the Board,. You may be surprised where the fault lies (orthopod vs dentist) if a case over premedication goes to court.

We are not attorneys and know full well that cases are won based on many factors.

S. F.

Thank you both for your time

Thank you for participating!

Dr. Ronald Salyk

What is your justification for Case 2?

Generally, patients do not require antibiotic premedication while undergoing dialysis, except if incision and drainage for an abscess is planned. In case 2, the patient had a complicated medical history, including ESRD, a failed kidney transplant, was undergoing dialysis 3 days per week, had HTN and Type 2 diabetes, and required urgent treatment for an abscess.

Dr. Monica Rado

Thank You Ann and JoAnn!

Thank you for participating!

J. G.

JON G
Thank You

Thank you for participating!

Dr. Olga Bernadiner

Thank you!

Thank you for participating!

Mr. Bisi Ekundayo

very informative session. thank you

Thank you for participating!

J. M.

thank you

Thank you for participating!

Anonymous

Thank you. Good Presentation.G.A.

Thank you for participating!

J. G.

If a patient has an upcoming joint replacement (within a month), is it recommended to postpone a dental cleaning?

Provide the dental hygiene appointment prior to the joint replacement procedure.

R. B.

Thank you for your time and expertise. Great seminar.
Dr RLB

Thank you for participating!

Dr. Michael Najera

Would antibiotic coverage be appropriate for the 1st six months for a cardiac stent

Antibiotic coverage is not needed for stents placed in coronary arteries.

B. M.

Thank you for all of the useful information

Thank you for participating!

R. B.

Thank you for the very informative information.

Thank you for participating!

K. A.

Thank you for the updated advice and guidelines.

Thank you for participating!

Ms. MaryAnn Hugh

That second case- my question is would you want the antibiotics to be in his system for at least 1 hour before beginning treatment?

Preferably.

Dr. Thomas Roderick

Restate THE AAOS portal for decision help/recommendations?
Thanks

http://www.orthoguidelines.org/go/auc/

Ms. Bridget Dorsey

what was the app again?

http://www.orthoguidelines.org/go/auc/

D. M.

What was the name of the app we can use to help determine if pre med is necessary?

http://www.orthoguidelines.org/go/auc/

Ms. Amanda Stites

Can you restate the app to download that you mentioned earlier about joe to decide when and when not to use pre med?

http://www.orthoguidelines.org/go/auc/

K. D.

THE APP NAME AGAIN, PLEASE

http://www.orthoguidelines.org/go/auc/

M. D.

please give the name of the APP again

http://www.orthoguidelines.org/go/auc/

N. M.

thank you for shedding light on this topic

Thank you for participating!

Mr. sadek bakdach

what is the relation between diabetes and antibiotics prescriptions ?

Unfortunately, we don't understand your question. is there a specific situation that you are asking about regarding use of antibiotics in patients with diabetes?

J. P.

when do we know to prescribe antibodies ? Biopsy ?

The decision to prescribe antibiotics is based upon a diagnosis of infection. Antibiotics are only effective against bacteria, so you would need a culture versus a biopsy.

R. G.

IF A PATIENT HAS AN AUTOIMMUNE DISEASE SHOULD PREMED BE GIVEN

Generally, there is no need for premed in a patient with an autoimmune disease alone. Patients with advanced forms of autoimmune diseases often have multi-organ system involvement, which could involve damage to the heart. Immune modulators used in long-term management of autoimmune disease may alter white blood cell count. A medical consultation with the patient's rheumatologist is warranted to make decisions for premed based upon each patient's unique circumstances. There are no set guidelines for premed and autoimmune disease. Please review the AAOS appropriate use criteria for dental management of patients with prosthetic joints to learn about who the AAOS considered to be immunocompromised.

K. M.

I've noticed medical professionals occasionally suggest not completing the full course of antibiotic. I had surgery & prescribed an antibiotic, the physician then suggested I discontinue the antibiotic after day 4. I was trained to complete the entire course of antibiotic, your thoughts please.

Some new research suggests that the need to have a 7 to 10 day course of antibiotics may not be necessary. In medicine, we are observing shorter courses of duration for antibiotic use. The patient's response to treatment is also an important consideration. Generally, we still recommend finishing the course to completion - what is changing is the duration of the course of therapy.

D. R.

Antibiotics maybe with humira?

Taking an immune modulatory drug is not in itself an indication for the need for an antibiotic.

Dr. Shuet Loke

For heart problems, the dentist normally follow the advice of the cardiologist to prescribe antibiotic prophylaxis or not, even if it doesn't fall into the criteria. How can dentists justify to make the final decision? Tq

Dental professionals should be current in their understanding about indications that require prophylaxis. If there is a question about whether prophylaxis is needed, a medical consultation should request clarification about why the antibiotic is necessary. For example, if a patient has a condition or device that the dentist is unfamiliar with, a medical consult is essential to understand the patient's cardiac status. Conversely, the dentist should clearly inform the cardiologist about what dental procedures are planned with related risks for bleeding, including the patient's oral hygiene and periodontal status. The consultation is bidirectional so that the best decision is made for the patient. Remember that unnecessary antibiotic use is not a good decision either.

J. P.

IF WE DONT GIVE ANTIBODY FOR DENTAL IMPLANT AND BONE GRAFTING , WOULDN'T THEY HAVE A RISK OF INFECTION OR FAILURE OF AN
IMPLANT?

Currently, there are recommendations to use antibiotics at the time of implant placement surgery to reduce risk for failure. However, the regimens are not consistent in terms of which antibiotic to use, dosage and duration of treatment.

R. G.

BESIDES DRUG IV ABUSE AND VALVE DAMAGE...DO WE PREMED ALL VALVE DAMAGE PATIENTS.

Some patients have leaky valves that do not require prophylaxis. A medical consultation should be sent to the cardiologist requesting information about the status of the heart valve(s) and risk for endocarditis.

Tina Day

What about testicular implants

There are no guidelines for testicular implants - I am assuming the patient had either an injury which required removal of the testes or testicular cancer. A medical consultation is warranted.

T. W.

how a bout ports for chemotherapy?

In-dwelling vascular access ports, such as those used during chemotherapy may require prophylaxis. There are no guidelines for these patients. If the patient is actively undergoing chemotherapy, then you need to know the patient's status, including their white blood cell count - which may require prophylaxis. A medical consultation should be sent to the oncologist.

Miss Chenxin Li

Do you recommend med consult for antiobiotic prophy for pts in which there is no guidelines?

I think that a medical consultation is always a good idea so that you can learn more about the patient's current medical status to support shared decision making around the need for prophylaxis

Dr. Michael Favero

Hi Dr. Spolarich!!! Fellow ASDOH friend Class of '08

Thank you for the pharm knowledge, I still educate patients on Tylenol the way you taught us!

Thanks Michael! Great to hear from you and hope you are doing well!

Dr. Dana Onet

For patients with pacemakers there is no need within the first few weeks after the procedure?

I would not see a patient within a few weeks after pacemaker insertion. The cardiologist should give the all clear that it is safe to treat the patient. Remember that we want to know that the patient responded favorably to the pacemaker insertion and that their rhythm is normal before providing dental treatment. That is the bigger concern for the patient. Get a med consult about cardiac status and when is it safe to treat.

R. G.

A COUPLE OF MY PATIENTS GAVE ME THEIR ID CARD OPERTAINING TO PACEMAKER AND DEFIRILLATOR. CARD SAID TO PREMED SO...WE SHOULD ASK TO SEE THEIR CARDS AND I MAKE COPIES OF IT FOR THEIR CHART

Yes and make copies for the chart. Get a med consult in writing with explanation about need for prophylaxis.

Irene Verdream

How about wisdom teeth extraction?

No antibiotic prophylaxis for wisdom tooth extraction. Need for post-op antibiotics is based on presence of infection

Danielle Brown

Patient has history of joint infection which caused them to have to have a replacement re-done 4 yrs after the original joint replacement(knee). Should they always be pre-medicated? The new ortho Dr told the patient no premed after 2 years with the new Knee replacement.Patient is very concerned!

Use the AAOS appropriate use criteria algorithm to determine the need for premed. Previous history of prosthetic joint infection is a risk factor. Get a written med consultt from the new orthopedic surgeon to document his recommendation for the patient

Prof. Barbara Dixon RDH, M.Ed.

ASA III patients more likely to benefit from ABX prophylaxis?

ASA III or higher have multiple co-morbidities. We don't premed just because of having ASA III or higher status. If at risk for endocarditis or prosthetic joint infection, poor ASA status may increase risk.

M. O.

What about patients with rhumatic fever?

Premed if patient developed valve disease as a result of having rheumatic fever

Betty Sanders

If you have a port but not getting chemo is premed needed

If a person is actively undergoing chemotherapy with an in-dwelling port, they may require antibiotic premedication, but there are not clinical guidelines. However, if the person is not getting chemotherapy, no premedication may be warranted. In this instance, a consult with the oncologist can be performed noting that the patient's WBC count should be within normal limits and the patient should be capable of withstanding dental and dental hygiene treatment.

D. R.

do you think a problem with all the increase in hand hygiene with antimicrobials ?

One of the best thing associated with the coronavirus is that we are all learning to wash our hands properly and at the appropriate times.

Wm Octave

What practice guidelines would you recommend when dealing with TeleHEALTH patients over the phone. (synchronous)

This, of course, would depend on each individual situation. Remember, to document the clinical situation, treatment proposed, patient consent, and other considerations discussed.

S. A.

In case 2 we can suggest neutrophil count for antibiotic prescription, not only medical history, what do you think about it

In case 2, you certainly can suggest blood studies be performed, but the patient is seeing you for urgent treatment, so you will want to take action.

Dr. Michelle Angeles

Do you always prescribe antibiotics after extraction?

Antibiotics are prescribed based on the presence of infection; not for routine extractions or other routine procedures.

Mrs. Jeana Shroyer

What is considered “invasive” on the app question? If a patient has elevated inflammation or it has been a long time since last prophet, there could be more bleeding.

Procedures that cause bleeding, i.e. debridement, extractions, would be considered invasive.

Dr. Gerald Strassberger

With the given example of the male with a complex past and present medical history, and an acute abscess, for which you both agreed antibiotic use was best, what antibiotic regimen would you use for this patient with impaired kidney function on dialysis?

If you are uncertain which antibiotics to prescribe, follow the American Heart Association guidelines https://www.heart.org/-/media/data-import/downloadables/c/b/3/pe-pdf-chd-infectiveendocarditiswalletcard-ucm_307644.pdf?la=en

A. E.

Do you see any future use of Phage therapy in dentistry?

It may be too early to know if phage therapy will be used in dentistry. Stay tuned!

J. P.

IF A PT HAS SINUS ISSUE/ SEASONAL ALLERGY. SHOULD WE PRESCRIBE ANTIBODY? WOULD THERE BE
RISK OF BACTERIA AFTER IMPLANT)??? THANK YOU

Many physicians have moved away from prescribing antibiotics for sinus/seasonal allergy problems. Antibiotics are prescribed for infections. Therefore, it is important to establish if the patient actually has an infection and requires antibiotic therapy. If they are taking an antibiotic and you are planning to place an implant and want to prescribe a different antibiotic, follow the American Heart Association guidelines https://www.heart.org/-/media/data-import/downloadables/c/b/3/pe-pdf-chd-infectiveendocarditiswalletcard-ucm_307644.pdf?la=en

Dr. Jeffrey Ross

Is there any time frame following prosthetic joint surgery that AB prophylaxis should be employed? ex. 6 mos, 1 year ?

Current guidelines do not recommend using antibiotics for joint replacement surgery in healthy individuals. Time is no longer a parameter in consideration. Feel free to review the orthopedic guidelines at http://www.orthoguidelines.org/go/auc/

Dr. Shuet Loke

We need to take informed consent for premed and post med antibiotics? Can patients refuse?

You must always obtain informed consent for procedures and if a patient refuses, use an informed refusal form.

Miss Nivedita Sharma

If patient has high glycemic index and we know that the blood glucose testing level is above 200mg/dL%. Antibiotics prophylaxis be given regardless of the invasive procedure?

You should not prescribe antibiotics based on a blood glucose level; you prescribe antibiotics based on the presence of infection.

Dr. Linton SJBarangan

Thank you for the informative lecture.

Thank you for participating!

Mr. Carlos Pinero

Which antiobiotic would you recommend for case 2 ?

Follow the American Heart Association guidelines https://www.heart.org/-/media/data-import/downloadables/c/b/3/pe-pdf-chd-infectiveendocarditiswalletcard-ucm_307644.pdf?la=en

Dr. Sarah Samuel

So we don’t need to premed for dialysis shunts?

There are no clinical guidelines to follow; typically there is no need to premedicate unless the patient presents with an abscess or the presence of other infection.

G. N.

What about the patient who definitely requires prophylactic antibiotic coverage and has complex treatment needs that will require multiple visits to complete. What is the best schedule for treatment? Dr/ Gerry

Follow the American Heart Association guidelines https://www.heart.org/-/media/data-import/downloadables/c/b/3/pe-pdf-chd-infectiveendocarditiswalletcard-ucm_307644.pdf?la=en

W. W.

Isn’t it ultimately the physicians decision on whether premed is needed and for how long??

Physicians make decisions about medical problems. Dentists and dental hygienists make decisions about oral health problems. We need to stop asking physicians to make decisions about oral health care. If you are seeing a patient and providing oral health care, you are the one who is to make the decision about premedication.

Victor Alos

cellulitis uncontrolled diabetes why not rx antibiotics

Antibiotics are prescribed for infections. Cellulitis represents an infection and requires antibiotic therapy to treat it regardless of other comorbidities.

Ms. Honey Bouganim

what is the role of the hygienist when dealing with a dentist who is old school?

Education! Hygienists are typically the education specialists in the practice. Create opportunities to discuss new clinical practice guidelines and/or articles during lunchtime or staff meetings.

TINTU CHITHAMBARA NATARAJAN

What impact does the dosages of antibiotics in periodontics influence?
Please give a brief note on pediatric patients prophylaxis if any?

Please see this article from the American Association of Pediatric Dentistry: https://www.aapd.org/media/Policies_Guidelines/BP_Prophylaxis.pdf

R. H.

Excelente Sesión!! Saludos desde la Cdmx

Thank you

katherine Juszczyk

From Australia
Who has the last say orthopaedic surgeon or dentist

I would encourage you to consult with dental regulations and the Australian Dental Association for guidance. However, in the U.S., if the patient is in the dental chair, the dentist is responsible for making the decision. If questions, a medical consultation can be used to gain more information about the patient's orthopedic surgical history and outcomes to support decision-making.

Arti Lamba

Why is it that PCN allergic patient can take amoxicillin?

Patients who are truly allergic to penicillin will be allergic to all penicillins - including amoxicillin. Thus, amoxicillin should not be given. If a patient can take amoxicillin without problems, I would suspect that the patient does not have a true allergy (eg. nausea or other notable side effects associated with antibiotics).

J. C.

I have had some physicians ask to premed patients with mitral valve regurgitation. I was taught that is true only if the leaflets were calcified and more likely to develop IE

You may recall that we used to premed for mitral valve prolapse with regurgitation. Usually, the regurgitation is not problematic unless the valve also has damage that will require the valve to be replaced. We don't typically premed for this condition.

Miss Jennifer Silva

for patients with joint replacements, is there still a need to consult with their physician?

If you follow the American Academy of Orthopedic Surgeons Appropriate Use Criteria (endorsed by the American Dental Association), the article that appears in the Journal of the American Dental Association (February 2017) states that you no longer need to contact the orthopedic surgeon.

M. P.

What do you prescribe a patient with penicillin and clindamycin?

I don't understand the question - do you mean if the patient is allergic to penicillin and clindamycin? You could use one of the alternative macrolides (azithromycin or clarithromycin)

T. K.

Not sure if it’s been asked; but is it mandatory for antibiotic prior to an extraction of a molar that has had prior endo but looks like it has an abscess?

Check out the new American Dental Association clinical practice guidelines from November 2019: Antibiotic Use for the Urgent Management of Dental Pain and Intra-oral Swelling Clinical Practice Guideline (2019) https://ebd.ada.org/en/evidence/guidelines/antibiotics-for-dental-pain-and-swelling?utm_source=EBDsite&utm_content=guidelines

L. P.

Colloidal silver? What about that instead, as it is amazing

This is beyond the scope of the presentation today.

R. F.

Thank you. Excellent conference Dra. Ann

Thank you for joining us

N. B.

but remember if the stent was placed due to a MI event- no dental tx for 6mos.

Correct! But not all patients receive stents due to MI. The issue in that situation is make sure the the stent has been effective and that the antiplatelet regimen has effectively prevented late stent thrombosis.

S. M.

Chemotherapy leading to low ejection fraction

Not an indication for antibiotic prophylaxis. Greater concern with cardiac function and cardiac status

M. L.

can it hurt to complete a prescription

Having a prescription for premed to keep on hand is convenient for some patients. But we don't want to create a situation for "hoarding" antibiotics that could be used to self-medicate for something else. Plus there is a financial "cost" for filling a prescription that might be unnecessary and/or not used and/or expires before it is needed.

Dr. Jerry Brown

But if the patient suffers IE or an infected joint the dentist will be liable for that decision

If the dentist follows the standard of care, it would be hard to make the case against the dentist. Remember that we can't control whether or not someone will sue. Many of these claims get thrown out long before they go to court. The burden of proof would lie with the person who would have to be able to demonstrate that the infection came from bugs from the oral cavity. Remember too that it is not the standard of care to prescribe medications that are not necessary.

R. C.

What is considered a comfortable AIC for DH procedures?

There is no set A1C as a "cut off" for dental hygiene treatment. The purpose of the A1C is to understand the level of glycemic control in the patient across time - and how it has been trending for the past year. The higher the A1C, the more poor the glycemic control - so risk for medical emergencies, and more likely that the patient will have worsening of existing periodontal disease.

R. K.

If the patient is on thyroid medication,what is the best recommendation in this case?

Thyroid medication would not have an impact on this case.

O. C.

What about a patient who a history of sepsis after hip replacement surgery? Does he or she needs to premedication?

Did the hip replacement also fail? If so, then likely premed would be indicated. I would encourage you to do a medical consultation with the orthopedic surgeon.

Mrs. alejandra dedios

what if as a hygienist you dont think antibiotics arent necessary but dentist insists on taking them and has old school views on premedication?

I would encourage you to bring all of the new clinical practice guidelines from the ADA and the AAOS and plan a meaningful staff meeting to discuss these guidelines and the implications for your practice. I would also check out a CE course on this topic and encourage your entire office to take this course. Remember: this webinar is being recorded for future viewing!

Mrs. Stefka Terzieva

Are the hygienists in USA legally can prescribe antibiotics? In Australia we are not allowed. Only the dentist can do it.

Hygienists do not prescribe antibiotics in the United States.

Arti Lamba

I get several pts saying they are allergic to penicillin but got amoxicillin for premed And has taken that before- should I get concerned and call the prescriber to change that Med?

Yes. But first, you need to confirm if the reported penicillin allergy is a true allergy. Question the patient about the nature of their reaction. If someone is allergic to one penicillin they will be allergic to all penicillins. Many people think that if they experienced adverse events (eg. nausea, diarrhea), they are "allergic" to the antibiotic.

F. R.

Does a person have to take antibiotics for the rest of their life if they have had a heart valve replacement ?

Yes

Mrs. michele shields

Doctors don’t want to be responsible if a patient gets infected by a prophylaxis. It is safer for them to prevent?

This question is a bit unclear. I think that you mean that the doctor doesn't want to be responsible for the potential risk for IE/PJI and will give the premed "preventively" instead. We have explained about the risks associated with unnecessary antibiotic use. It is not appropriate to put drugs on board that are not needed.

Mrs. Carmen Toronto

Is premed necessary for lupus pts? My pt will not get any work done unless she premeds.

We don't premed a patient with lupus just because of the diagnosis of lupus. But patients with lupus have multi-organ system involvement - so the real issue is does the patient have consequences as a result of the lupus (eg. damage to the heart) that may require premed. Also, patients with autoimmune diseases take medications that modulate the immune system. You may want labs on that patient to assess their white cell count. A med consult would be helpful to determine the need for premed.

Dr. Divina Cadahing

is it SOP to premedicate patients for surgical removal of impacted third molars in patients that are nit medically compromised?

This is beyond the scope of this presentation. Please consult the literature for guidance.

J. P.

MANY IMPLANT DOCTORS PRESCRIBE AUGMENTIN INSTEAD OF AMOXICILLIN OR CLINDAMYCIN ??
I KNOW AUGMENTIN IS STRONGER THAN CLINDAYCIN/AMOXICIIN BUT WHY DO THEY PREFER AUGMENTIN >? THANK YOU

It is inappropriate to use Augmentin for prophylaxis. Augmentin is used when causative bacteria are resistant to the penicillins. It should be reserved for those circumstances when patients have infections that are not responding to a more narrow spectrum antibiotic (eg. penicillin or amoxicillin)

Dr. Shuet Loke

my 3yr old cousin just had his transposed heart, repair of valves and arteries but only prescribed antibiotics for a week post op. Is this the routine SOP currently? Tq

An interesting case. I cannot comment on this, but the repair sounds like the tissues were re-routed ("self to self") so with good pre-op/post-op care, it sounds like the 1 week regimen was sufficient to prevent post-op infection. Glad that things worked out well for him!

D. R.

If a patient needs a number of appointments and they are indicated for prophylaxis with antibiotics how long before the appointments to prevent resistance?

Typically, waiting 9 to 14 days between appointments helps to minimize the development of resistance. And - I would try to maximize the number of procedures done during those scheduled visits to reduce the need for repeated premed.

Miss Nivedita Sharma

Hello thank you for wonderful seminar. I have a question. If the patient has heart valve and patient comes for restoration, would antibiotics prophylaxis be prescribed or it can be given only if there's invasive procedure?

If you are doing an occlusal filling, premed is probably not necessary because you won't be causing a bleed. But for any other restorative work, I would give prophylaxis.

Mrs. Janice McElhaney

If a pt.is allergic to amoxicillan and penicillans, and clyndamiacin, what would the proper drug be to prescribe?

You could try one of the alternative macrolides, like clarithromycin or azithromycin

Dr. Carolin De La Rosa

What if the patient prefers to have only antibiotic therapy and avoid the needed dental treatment for their child (underage)?

This could be interpreted as supervised neglect on the part of the dentist. Also, if a parent is not addressing the child's dental health needs (eg. active caries), then this could be a case of child neglect. I would explain that we cannot just give antibiotics as they won't correct the problem. If the parent will not agree to have the child treated, then social services may need to be contacted for assistance. Remember that there is usually a reason why the parent is non-compliant: is it financial? Perhaps assistance from social services would be helpful.

T. W.

Should we always go with the orthopedic’s recommendation for pre med even if our Dr feels it’s not necessary?

Follow the new guidelines that we presented here from the American Association for Orthopedic Surgeons Appropriate Use Criteria that are endorsed by the American Dental Association. Notify the orthopedic surgeon that your practice follows these guidelines.

Ms. Elissa Schwartz

If the dentist thinks the patient does not need an antibiotic, but the patient's physician says the patient should take the antibiotic, how should the dentist handle making the decision?

Follow the clinical practice guidelines that we presented during the webinar from the ADA and the AAOS. Notify the physician that the practice follows current clinical practice guidelines and explain why you have determined that the patient does not require prophylaxis. The dentist is responsible for making the decision when the patient is in the dental chair.

Anonymous

Don’t you usually go with the recommendation of the medical doctor?

No.. Dental providers should follow published clinical practice guidelines from the American Heart Association, The American Dental Association, the American Association for Orthopedic Surgeons. Different professional associations/societies will have similar guidelines in other countries.

Dr. Monica Rado

How about postop antibiotic use?

This question is too general for me to answer - sorry. Consult the scientific literature for guidance.

Dr. Shruthi Srinivasan

Is there any open-access dataset that records the usage of antibiotics by dentists and what condition they prescribe it for? Including pre medication.

Not to my knowledge. Clinical practice guidelines are usually the best resources as they are based on the best available data.

S. V.

Amoxicillin or clindamycin or cephalosporins ?
Which is better for old age individuals?

The decision to use an antibiotic is not based on age. Dosage may be affected by age, as liver and kidney function decline with age. Consult a good drug reference guide for help

E. G.

Pregnant with severe periodontitis. Any antibiotic prophylaxis?

Neither pregnancy or periodontitis are indications for prophylaxis

Miss Nivedita Sharma

Hello, If patient is already taking amoxicillin for an existing dental infection. After how long we can give the same class. I have read it somewhere that we need to change the antibiotics class within next 14days....is it exact 2 weeks that after 2 weeks, we can give the same antibiotics?

Typically waiting 9 to 14 days between rounds of exposure helps to prevent the development of resistance if using the same medication. Remember that the dose used to treat an infection is significantly lower than the dose that we use for prophylaxis.

Miss Pakeeza Hussain

People with Diabetes, considering the fact, they tend to heal slow, so would it be indicated for them to take premedication antibiotics?

No - diabetes alone is not an indication for prophylaxis.

D. R.

antibiotic prophylaxis and implant evidence?

There is a general consensus that using antibiotics at the time of dental implant placement is very helpful. But there is a lack of consensus about which antibiotic, the dose and the length of the treatment period. Plus there is no research evidence (yet) documenting outcomes with one regimen versus another. Much of this research is ongoing

J. S.

is there different doses for antibiotics depending on the condition we are premedicating for?

No - follow the regimens stated in the American Heart Association for prevention of IE and PJI

S. V.

There are different studies regarding hydroxychloroquinine and azithromycin to be proven effective in case of COVID 19.
What is your opinion regarding that?

This is beyond the scope of this webinar discussion. Please refer to the scientific literature for information.

Prof. Vijay P Mathur

What about prophylaxis before bone marrow transplant in children? Which antibiotic should we give before dental extraction

Please get a medical consultation with the pediatric oncologist and transplant coordinator. The decision would be based on the patient's WBC count.

Arti Lamba

What is the critical A1C number that we can work?

There is no set A1C as a "cut off" for dental treatment. The purpose of the A1C is to understand the level of glycemic control in the patient across time - and how it has been trending for the past year. Elevated A1C also indicates risk for medical emergency and likely exacerbation of existing periodontal disease.

Miss Pakeeza Hussain

If somebody is on anticoagulants due to afib conditioning, and are prone to bleeding, wouldn't that increase the chances of bacteremia?

Patients on anticoagulants may experience more gingival bleeding with oral hygiene which is why they need to have immaculate oral hygiene. This would also reduce risk for bacteremia

Miss Ariadna Juarez

In patients with don't have the care of their mouth but they aren't immunocompromise and maybe have endodontic problem what is the best recommendation in this case ? Is necessary prescribed antibiotics or not ?

Check out the new American Dental Association clinical practice guidelines from November 2019: Antibiotic Use for the Urgent Management of Dental Pain and Intra-oral Swelling Clinical Practice Guideline (2019) https://ebd.ada.org/en/evidence/guidelines/antibiotics-for-dental-pain-and-swelling?utm_source=EBDsite&utm_content=guidelines

Aaron Johnson

How about patients that have an External heart pump.

Please consult the cardiologist for guidance. Likely the patient will require prophylaxis.

Dr. Monica Rado

How about antibiotic use in pregnant/nursing women?

Consult a drug reference guide to determine which antibiotics can be safely used in pregnant and lactating women. You may also consult with the patients obstetrician for advice.

S. K.

How would you spread the appointments if they need multiple visits with premedication?

Make longer appointments to maximize the number of procedures that you can do, then wait 2 weeks and schedule the next appointment.

Miss Nivedita Sharma

Patients with kidney transplant who are not on cyclosporine, do we need to give that patient antibiotics prophylaxis before any invasive procedure?

Unfortunately, there are no guidelines for transplant patients. Generally, we are seeing a trend moving away from giving prophylaxis for a transplant recipient - especially if they no longer need anti-rejection drugs like cyclosporine. Get a med consult with the transplant coordinator for assistance.

Mrs. Barbara Harvey

What is your recommendation on local delivery antibiotic therapies like Arrestin or the Perio-chip?

This is beyond the scope of this webinar. Antibiotics given by local delivery used as adjunctive therapy have been shown to increase attachment gain by up to 1 mm. This is likely not clinically significant for most patients.

S. M.

A patient had a lobectomy 4 weeks prior to their dental hygiene appointment. Pt. has advanced periodontal disease. Pre-med?

Unfortunately, you do not state the specific nature of the lobectomy: of the lung? thyroid gland? liver? Generally, no premed. The greater issue is whether or not the patient is medically stable post-surgery to undergo dental treatment. Please do a medical consultation with the specialist.

Ms. Juanita DeBruce

In light of Covid- 19 , where are we in Association with appropriate use?
I ask as a Dental Assistant.

We are exactly where we were before Covid-19. We still follow the clinical guidelines.

Rebecca Green

Great information!!

Thank you for your kind support!

Dr. Jeffrey Ross

It seems a large respected group of orthopods in the city I work in always seem to "require" premed for knee replacements mostly for"CYA" even according to patients. What is the best way to deal with this? Possibly just have the orthopod write the script which be a tremendous burden to pt

If you follow the American Academy of Orthopedic Surgeons Appropriate Use Criteria (endorsed by the American Dental Association), the article that appears in the Journal of the American Dental Association (February 2017) states that you no longer need to contact the orthopedic surgeon.

Mrs. Rachel Rachel

Thank you for the great information

Thank you for participating!