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Wilkins LE, Kharas AL, Wallace M. Prosthetic joint infection secondary to invasive dental treatment. Br Dent J 2024; 236:962-963. [PMID: 38942859 DOI: 10.1038/s41415-024-7571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/30/2024]
Affiliation(s)
| | - A L Kharas
- Oxford University Hospitals, Oxford, UK.
| | - M Wallace
- Gosford Hill Medical Centre, Kidlington, UK.
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2
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Lean SSH, Jou E, Ho JSY, Jou EGL. Prophylactic antibiotic use for infective endocarditis: a systematic review and meta-analysis. BMJ Open 2023; 13:e077026. [PMID: 37607797 PMCID: PMC10445353 DOI: 10.1136/bmjopen-2023-077026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES Infective endocarditis (IE) is a devastating disease with a 50% 1-year mortality rate. In recent years, medical authorities across the globe advised stricter criteria for antibiotic prophylaxis in patients with high risk of IE undergoing dental procedures. Whether such recommendations may increase the risk of IE in at-risk patients must be investigated. DESIGN Prospectively registered systematic review and meta-analysis. DATA SOURCES Medline, Embase, Scopus and ClinicalTrials.gov were searched through 23 May 2022, together with an updated search on 5 August 2023. ELIGIBILITY CRITERIA All primary studies reporting IE within 3 months of dental procedures in adults >18 years of age were included, while conference abstracts, reviews, case reports and case series involving fewer than 10 cases were excluded. DATA EXTRACTION AND SYNTHESIS All studies were assessed by two reviewers independently, and any discrepancies were further resolved through a third researcher. RESULTS Of the 3771 articles screened, 38 observational studies fit the inclusion criteria and were included in the study for subsequent analysis. Overall, 11% (95% CI 0.08 to 0.16, I2=100%) of IE are associated with recent dental procedures. Streptococcus viridans accounted for 69% (95% CI 0.46 to 0.85) of IE in patients who had undergone recent dental procedures, compared with only 21% (95% CI 0.17 to 0.26) in controls (p=0.003). None of the high-risk patients developed IE across all studies where 100% of the patients were treated with prophylactic antibiotics, and IE patients are 12% more likely to have undergone recent dental manipulation compared with matched controls (95% CI 1.00 to 1.26, p=0.048). CONCLUSIONS Although there is a lack of randomised control trials due to logistic difficulties in the literature on this topic, antibiotic prophylaxis are likely of benefit in reducing the incidence of IE in high-risk patients after dental procedures. Further well-designed high-quality case-control studies are required. TRIAL REGISTRATION NUMBER CRD42022326664.
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Affiliation(s)
- Sue S H Lean
- Department of Dental Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan
| | - Eric Jou
- Queens' College, University of Cambridge, Cambridge, UK
| | - Jamie Sin Ying Ho
- Department of Medicine, National University Health System, Singapore
| | - Ernest G L Jou
- Department of Dental Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan
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3
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Rahman A, Alqaisi S, Nath J. An Unexpected Outcome of Streptococcus sanguinis Endocarditis Associated With Orthodontic Bracing in a Young Healthy Patient. Cureus 2023; 15:e39864. [PMID: 37404441 PMCID: PMC10315059 DOI: 10.7759/cureus.39864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
We present a case of Streptococcus sanguinis endocarditis in a 26-year-old female following orthodontic bracing. The rarity and debilitating consequences of endocarditis caused by Streptococcus sanguinis are elaborated. The patient exhibited severe regurgitation with the eccentric posteriorly directed flow, leading to significant cardiac strain, further accentuated by systolic flow reversal in the right superior pulmonary vein. Surgical intervention, including mitral valve replacement, was crucial in addressing the underlying infection, restoring valve function, and preventing further complications. However, a second mitral valve replacement was performed due to recurrent bioprosthesis endocarditis. This case underscores the unique challenges of Streptococcus sanguinis endocarditis, emphasizing the need for a multidisciplinary approach and individualized decision-making to optimize patient care.
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Affiliation(s)
- Ali Rahman
- Internal Medicine, Mather Hospital, Northwell Health, Port Jefferson, USA
| | - Sura Alqaisi
- Internal Medicine, Memorial Healthcare, Pembroke Pines, USA
| | - Jayant Nath
- Cardiology/Imaging, Memorial Healthcare, Pembroke Pines, USA
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Bessa LJ, Botelho J, Machado V, Alves R, Mendes JJ. Managing Oral Health in the Context of Antimicrobial Resistance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416448. [PMID: 36554332 PMCID: PMC9778414 DOI: 10.3390/ijerph192416448] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 05/25/2023]
Abstract
The oral microbiome plays a major role in shaping oral health/disease state; thus, a main challenge for dental practitioners is to preserve or restore a balanced oral microbiome. Nonetheless, when pathogenic microorganisms install in the oral cavity and are incorporated into the oral biofilm, oral infections, such as gingivitis, dental caries, periodontitis, and peri-implantitis, can arise. Several prophylactic and treatment approaches are available nowadays, but most of them have been antibiotic-based. Given the actual context of antimicrobial resistance (AMR), antibiotic stewardship in dentistry would be a beneficial approach to optimize and avoid inappropriate or even unnecessary antibiotic use, representing a step towards precision medicine. Furthermore, the development of new effective treatment options to replace the need for antibiotics is being pursued, including the application of photodynamic therapy and the use of probiotics. In this review, we highlight the advances undergoing towards a better understanding of the oral microbiome and oral resistome. We also provide an updated overview of how dentists are adapting to better manage the treatment of oral infections given the problem of AMR.
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Affiliation(s)
- Lucinda J. Bessa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - João Botelho
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Clinical Research Unit (CRU), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Evidence-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - Vanessa Machado
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Clinical Research Unit (CRU), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Evidence-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - Ricardo Alves
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Clinical Research Unit (CRU), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - José João Mendes
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Clinical Research Unit (CRU), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Evidence-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
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Dentists’ Habits of Antibiotic Prescribing May be Influenced by Patient Requests for Prescriptions. Int J Dent 2022; 2022:5318753. [PMID: 36046696 PMCID: PMC9424009 DOI: 10.1155/2022/5318753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
Objective This study evaluates dentists' antibiotic prescribing habits and the frequency of facing patient pressure for prescriptions. Methods An online anonymous survey was used to collect data on antibiotic prescribing practices, including prescribing unnecessary antibiotics if requested by patients. Results The study population included 345 dentists; 227 (65.8%) were females and 118 (34.2%) were males. 54 (15.7%) reported that they prescribed unnecessary antibiotics more than once per week, 47 (13.6%) once per month, 135 (39.1%) rarely, and 109 (31.6%) never prescribed unnecessary antibiotics. 117 (33.9%) reported being pressured by patients to prescribe unnecessary antibiotics more than once per week. 110 (31.9%) reported being pressured by patients to do so at least once per month. There was a statistical difference between the two genders (P < 0.001) in reporting that patients pressured them to prescribe antibiotics when antibiotics were not necessary for treatment or prophylactic purposes and in prescribing unnecessary antibiotics sometimes if requested by a patient (P=0.008). In addition, there was a statistical difference in dentists' confidence in their knowledge and practice in the area of antibiotic prescribing (P < 0.001). Conclusions The results show that unnecessary antibiotic prescribing by dentists can be influenced by patient pressure.
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Budea CM, Pricop M, Bratosin F, Bogdan I, Saenger M, Ciorica O, Braescu L, Domuta EM, Grigoras ML, Citu C, Diaconu MM, Marincu I. Antibacterial and Antifungal Management in Relation to the Clinical Characteristics of Elderly Patients with Infective Endocarditis: A Retrospective Analysis. Antibiotics (Basel) 2022; 11:antibiotics11070956. [PMID: 35884210 PMCID: PMC9312084 DOI: 10.3390/antibiotics11070956] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 01/09/2023] Open
Abstract
Infective endocarditis (IE) is increasingly prevalent in the elderly, particularly due to the rising frequency of invasive procedures and intracardiac devices placed on these individuals. Several investigations have highlighted the unique clinical and echocardiographic characteristics, the microorganisms implicated, and the prognosis of IE in the elderly. In addition, the old population seems to be fairly diverse, ranging from healthy individuals with no medical history to patients with many ailments and those who are immobile. Furthermore, the therapy of IE in this group has not been well investigated, and worldwide recommendations do not propose tailoring the treatment approach to the patient’s functional state and comorbid conditions. A multicenter research study was designed as a retrospective study of hospitalized patients with infective endocarditis, aiming to examine the characteristics of elderly patients over 65 years old with infective endocarditis in relation to the antibiotic and antifungal treatments administered, as well as to quantify the incidence of treatment resistance, adverse effects, and mortality in comparison to patients younger than 65. Based on a convenience sampling method, we included in the analysis a total of 78 patients younger than 65 and 131 patients older than 65 years. A total of 140 patients had endocarditis on native valves and 69 patients had endocarditis on prosthetic valves. A significantly higher proportion of elderly patients had signs of heart failure on admission, and the mortality rate was significantly higher in the elderly population. A majority of infections had a vascular cause, followed by dental, maxillo-facial, and ENT interventions. The most common complications of IE were systemic sepsis (48.1% of patients older than 65 years vs. 30.8% in the younger group). The most frequent bacterium involved was Staphylococcus aureus, followed by Streptococcus spp. in a total of more than 50% of all patients. The most commonly used antibiotics were cephalosporins in 33.5% of cases, followed by penicillin in 31.2% and glycopeptides in 28.7%, while Fluconazole was the initial option of treatment for fungal endocarditis in 24.9% of cases. Heart failure at admission (OR = 4.07), the development of septic shock (OR = 6.19), treatment nephrotoxicity (OR = 3.14), severe treatment complications (OR = 4.65), and antibiotic resistance (OR = 3.24) were significant independent risk factors for mortality in the elderly patients. Even though therapeutic management was initiated sooner in the older patients, the associated complications and mortality rate remained significantly greater than those in the patients under 65 years old.
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Affiliation(s)
- Camelia Melania Budea
- Department of Ear-Nose-Throat, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (M.S.); (L.B.); (E.M.D.); (M.L.G.); (I.M.)
| | - Marius Pricop
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Correspondence:
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (M.S.); (L.B.); (E.M.D.); (M.L.G.); (I.M.)
| | - Iulia Bogdan
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (M.S.); (L.B.); (E.M.D.); (M.L.G.); (I.M.)
| | - Miriam Saenger
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (M.S.); (L.B.); (E.M.D.); (M.L.G.); (I.M.)
| | - Ovidiu Ciorica
- Business Administration and Economics Faculty, West University of Timisoara, Johann Heinrich Pestalozzi Street 16, 300115 Timisoara, Romania;
| | - Laurentiu Braescu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (M.S.); (L.B.); (E.M.D.); (M.L.G.); (I.M.)
- Department of Cardiovascular Surgery, Institute for Cardiovascular Diseases, Str. Gh. Adam nr. 13A, 300310 Timisoara, Romania
| | - Eugenia Maria Domuta
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (M.S.); (L.B.); (E.M.D.); (M.L.G.); (I.M.)
- Surgery Department, Faculty of Medicine and Pharmacy, University of Oradea, Piata 1 Decembrie 10, 410073 Oradea, Romania
| | - Mirela Loredana Grigoras
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (M.S.); (L.B.); (E.M.D.); (M.L.G.); (I.M.)
- Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cosmin Citu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.C.); (M.M.D.)
| | - Mircea Mihai Diaconu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.C.); (M.M.D.)
| | - Iosif Marincu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (M.S.); (L.B.); (E.M.D.); (M.L.G.); (I.M.)
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Angarita-Díaz MDP, Bernal-Cepeda L, Bastidas-Legarda L, Forero-Escobar D, Ricaurte-Avendaño A, Mora-Reina J, Vergara-Mercado M, Herrera-Herrera A, Rodriguez-Paz M, Cáceres- Matta S, Fortich-Mesa N, Ochoa-Acosta EM. Impact of a virtual learning environment on the conscious prescription of antibiotics among Colombian dentists. PLoS One 2022; 17:e0262731. [PMID: 35089952 PMCID: PMC8797226 DOI: 10.1371/journal.pone.0262731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022] Open
Abstract
Appropriate antibiotic prescription contributes to reducing bacterial resistance; therefore, it is critical to provide training regarding this challenge. The objective of this study was to develop a virtual learning environment for antibiotic prescription and to determine its impact on dentists' awareness, attitudes, and intention to practice. First, the learning content on multimedia resources was developed and distributed into three challenges that participants had to overcome. Then, a quasi-experimental study was performed in which the virtual learning environment was implemented on dentists from seven Colombian cities. The median of correct answers and the levels of awareness, attitudes, and intention to practice were compared before, immediately after, and 6-months post-intervention. Wilcoxon signed-rank and McNemar's tests were used to determine the differences. A total of 206 participants who finished the virtual learning environment activities exhibited a favorable and statistically significant impact on the median of correct answers of awareness (p < 0.001), attitudes (p < 0.001), and intention to practice (p = 0.042). A significant increase occurred in the number of participants with a high level of awareness (p < 0.001) and a non-significant increase in participants with high levels of attitudes (p = 0.230) and intention to practice (p = 0.286). At 6 months, the positive effect on the median of correct answers on awareness and intention to practice persisted (p < 0.001); however, this was not evident for attitudes (p = 0.105). Moreover, there was a significant decrease in the number of participants who showed low levels of awareness (p = 0.019) and a slight increase in those with high levels of the same component (p = 0.161). The use of a virtual learning environment designed for dentists contributed to a rapid improvement in awareness and intention to practice antibiotic prescription; however, their attitudes and information retention need reinforcement.
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Affiliation(s)
| | | | - Leidy Bastidas-Legarda
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Diana Forero-Escobar
- Facultad de Odontología, Universidad Cooperativa de Colombia, Villavicencio, Colombia
| | | | - Julián Mora-Reina
- Facultad de Odontología, Universidad Cooperativa de Colombia, Villavicencio, Colombia
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Rexhepi A, Latifi-Xhemajli B, Kutllovci T, Bajrami S, Ahmeti D. Caries Experience and Knowledge About Oral Health Importance Among Children with Congenital Heart Diseases in Kosovo. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] Open
Affiliation(s)
- Aida Rexhepi
- University Dentistry, Kosovo; University of Business and Technology, Kosovo
| | | | - Teuta Kutllovci
- University Dentistry, Kosovo; Campus College Rezonanca, Kosovo
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Katz JN, Song ZS, Stanley EE, Lenhard NK, Silva GS, Chen A, Thornhill TS, Lange J, Collins JE, Selzer F, Losina E. Factors associated with use of antibiotic prophylaxis following dental procedures in total joint replacement recipients. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100217. [DOI: 10.1016/j.ocarto.2021.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022] Open
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Rela R, Sejao AV, Singh A, Singh PK, Kumar M, Gupta SK, Rangari P. Antibiotic Prescribing Knowledge, Awareness, and Attitude of Dental Surgeons Practicing in the Urban Indian Population. J Pharm Bioallied Sci 2021; 13:S1637-S1641. [PMID: 35018045 PMCID: PMC8686960 DOI: 10.4103/jpbs.jpbs_394_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies have reported that dental procedures may serve as a portal of entry for bacteria into the blood circulation, commonly termed as bacteremia which may inhabitate the heart and joints subjected to repair and replacement by prosthesis and may lead to complications in immunocompromised patients. Dental procedure may play a pivotal role in the development of infective endocarditis and infection around the prosthetic joint. Antibiotic use is suggested for all dental procedures requiring gingival manipulation or of the periapical region of teeth or mucosal incision in these patients. OBJECTIVE The present study has been conducted to inspect the antibiotic prescribing practices of general dentists among 250 dental practitioners. METHODS The study was conducted on 250 dental surgeons practicing in the urban Indian population of various parts of the country. A validated questionnaire was developed by a multidisciplinary dental and medical team and was circulated on the subject of the basic knowledge and awareness about antibiotic prophylaxis in susceptible patients. The data from the participants were collected, collated, and statistically analyzed. RESULTS The present study comprised 250 dental surgeons; 178 out of 250 were male, whereas 72 were female. Antibiotic prophylaxis guidelines were followed by 169 practitioners (67.60%), whereas 81 (32.40%) dentists did not follow any guidelines. Out of 169, 67 followed the American Academy of Orthopaedic Surgeons (AAOS) guidelines (39.64%), 58 followed American Heart Association (AHA) guidelines (34.30%), whereas 44 followed general physician's guidelines (26.03%). On screening the underlying conditions for which antibiotic cover was prescribed, it was shown that majority of the dental surgeons did the same for patients with cardiac valve repair or replacement (230; 92%), followed by infective endocarditis (212; 84.80%); organ transplant (212; 84.405); diabetes (189; 75.60%); prosthetic joint replacement (150; 60%); and congenital heart defect (110; 44%). CONCLUSION Patients should then be trained to perform meticulous oral hygiene and advised to schedule regular dental checkups to maintain optimal dental health. Dentists should use antibiotic prophylaxis in only conditions associated with a valid scientific basis and should follow the standard protocols recommended by the American Dental Association, AHA, or AAOS.
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Affiliation(s)
- Rathi Rela
- Department of Oral Medicine and Radiology, Nalanda Medical College And Hospital, Patna, Bihar, India
| | - Aarti Vidyasindhu Sejao
- Department of Community Medicine, Dr. N.Y. Tasgaonkar Institute of Medical Science, Karjat, Raigad, Maharashtra, India
| | - Ankita Singh
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Prabhat Kumar Singh
- Department of Periodontics, Buddha Institute of dental sciences and hospital, Patna, Bihar, India
| | - Mukesh Kumar
- Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India,Address for correspondence: Dr. Mukesh Kumar, Assistant Professor of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. E-mail:
| | - Shweta Kirti Gupta
- Dept of Pedodontics and Preventive Dentistry, Senior Lecturer, Kalka Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Priyadarshini Rangari
- Department of Dentistry, Sri Shankaracharya Medical College, Bhilai, Durg Chhattisgarh, India
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Del Giudice C, Vaia E, Liccardo D, Marzano F, Valletta A, Spagnuolo G, Ferrara N, Rengo C, Cannavo A, Rengo G. Infective Endocarditis: A Focus on Oral Microbiota. Microorganisms 2021; 9:1218. [PMID: 34199916 PMCID: PMC8227130 DOI: 10.3390/microorganisms9061218] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis (IE) is an inflammatory disease usually caused by bacteria entering the bloodstream and settling in the heart lining valves or blood vessels. Despite modern antimicrobial and surgical treatments, IE continues to cause substantial morbidity and mortality. Thus, primary prevention and enhanced diagnosis remain the most important strategies to fight this disease. In this regard, it is worth noting that for over 50 years, oral microbiota has been considered one of the significant risk factors for IE. Indeed, among the disparate recommendations from the American heart association and the European Society of Cardiology, there are good oral hygiene and prophylaxis for high-risk patients undergoing dental procedures. Thus, significant interest has grown in the role of oral microbiota and it continues to be a subject of research interest, especially if we consider that antimicrobial treatments can generate drug-resistant mutant bacteria, becoming a severe social problem. This review will describe the current knowledge about the relationship between oral microbiota, dental procedures, and IE. Further, it will discuss current methods used to prevent IE cases that originate from oral pathogens and how these should be focused on improving oral hygiene, which remains the significant persuasible way to prevent bacteremia and systemic disorders.
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Affiliation(s)
- Carmela Del Giudice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.D.G.); (E.V.); (A.V.); (G.S.)
| | - Emanuele Vaia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.D.G.); (E.V.); (A.V.); (G.S.)
| | - Daniela Liccardo
- Department of Translational Medical Sciences, Medicine Federico II University of Naples, 80131 Naples, Italy; (D.L.); (N.F.); (G.R.)
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Alessandra Valletta
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.D.G.); (E.V.); (A.V.); (G.S.)
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.D.G.); (E.V.); (A.V.); (G.S.)
- Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Medicine Federico II University of Naples, 80131 Naples, Italy; (D.L.); (N.F.); (G.R.)
- Istituti Clinici Scientifici ICS-Maugeri, 82037 Telese Terme, Italy
| | - Carlo Rengo
- Department of Prosthodontics and Dental Materials, School of Dental Medicine, University of Siena, 53100 Siena, Italy;
| | - Alessandro Cannavo
- Department of Translational Medical Sciences, Medicine Federico II University of Naples, 80131 Naples, Italy; (D.L.); (N.F.); (G.R.)
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Medicine Federico II University of Naples, 80131 Naples, Italy; (D.L.); (N.F.); (G.R.)
- Istituti Clinici Scientifici ICS-Maugeri, 82037 Telese Terme, Italy
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Truong T, Koh Y, Yosufi R, Marangou J, Slack-Smith L, Katzenellenbogen JM. Understanding valvular heart disease in the dental setting. Aust Dent J 2021; 66:254-261. [PMID: 33448018 DOI: 10.1111/adj.12821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited evidence is available regarding dentists' knowledge and interpretation of infective endocarditis (IE) prophylaxis guidelines. The aim of this study was to determine understanding and management of rheumatic and non-rheumatic valvular heart disease (VHD) in the dental setting in Western Australia (WA). METHODS A cross-sectional survey of dentists within Perth utilized an online Qualtrics questionnaire developed after consultation with stakeholders. A sampling frame was compiled from the Australian Health Practitioner Regulation Agency with contact details obtained from the White Pages (online), using five quintiles of Socio-Economic Indexes for Areas according to dentist's place of practice. RESULTS Of 41 (13.7% of 300 approached) dentists completing the survey (95.1% general dentists, mean years of practice = 15.6), 90.2% reported following the Australian Therapeutic Guidelines (ATG) regarding IE antibiotic prophylaxis in VHD. Most (92.7%) were unaware of the rheumatic heart disease (RHD) control program. Nearly all participants indicated prophylaxis for clearly invasive procedures such as tooth extraction (100.0%) and periodontal surgery (95.1%). Many dentists made the decision to prescribe antibiotics themselves (36.6%). CONCLUSIONS The majority of dentists followed the ATG's IE prophylaxis recommendations for cardiac lesions and dental procedures. There was limited knowledge of the national RHD guidelines and the WA RHD control program.
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Affiliation(s)
- T Truong
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Y Koh
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - R Yosufi
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - J Marangou
- Department of Cardiology, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA, Australia.,Department of Health Western Australia, Perth, WA, Australia
| | - L Slack-Smith
- UWA Dental School, The University of Western Australia, Perth, WA, Australia.,School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - J M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
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13
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De Wolf D, Genouw A, Standaert C, Victor A, Vanoverbeke N, De Groote K, Martens L. Endocarditis prophylaxis in daily practice of pediatricians and dentists in Flanders. Eur J Pediatr 2021; 180:397-405. [PMID: 32780192 DOI: 10.1007/s00431-020-03769-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
Endocarditis is a potentially life-threatening disease in children with congenital heart disease (CHD) and correct prophylaxis (EP) is of utmost importance. We conducted two surveys among pediatricians and dentists in Flanders about their knowledge of EP guidelines. The survey was completed by 910 dentists and 100 pediatricians. Sixty-five percent of the dentists did not know any guideline. They relied for information on the internet or the child's physician. 87% identified low risk treatments correctly, but only 64% identified high risk procedures correctly. Eighty-three percent asked for the presence of CHD and allergy to antibiotics. Dentists asked advice of the patient's physician, but 29% would withhold treatments in high-risk patients and 50% did not know the pediatric antibiotic dosages. Forty-seven percent of the pediatricians did not know EP guidelines and they would preferably contact the child's cardiologist. Pediatricians had difficulties with the identification of low-risk procedures and would give unnecessary antibiotics. They identified most CHD at high risk, but scored lower for the identification of lower risk CHD.Conclusion: The knowledge of Flemish dentists and pediatricians of EP guidelines is low. The knowledge about EP guidelines and the communication between dentists and pediatricians should be improved. Patients should be provided with an individual EP card. What is Known: • The knowledge of dentists and cardiologists about EP is not perfect, which has already been described. • There are several guidelines about EP, and they are not identical and sometimes confusing. What is New: • This is the first article combining large scale surveys of the knowledge and application of EP by dentists and pediatricians, allowing us to compare knowledge and gaps of knowledge and use their complementarity in order to offer tailored solutions and use patient education and partnership.
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Affiliation(s)
- Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
| | | | | | | | | | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Luc Martens
- Department of Oral Health Sciences, Ghent University, Ghent, Belgium
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14
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Danilkowicz RM, Lachiewicz AM, Lorenzana DJ, Barton KD, Lachiewicz PF. Prosthetic Joint Infection After Dental Work: Is the Correct Prophylaxis Being Prescribed? A Systematic Review. Arthroplast Today 2021; 7:69-75. [PMID: 33521200 PMCID: PMC7818599 DOI: 10.1016/j.artd.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 11/11/2020] [Indexed: 02/02/2023] Open
Abstract
Background Prosthetic joint infection (PJI) of total hip (THA) or total knee arthroplasty (TKA) after dental procedures is uncommon, and antibiotic prophylaxis remains controversial. For high-risk patients, the American Academy of Orthopedic Surgeons recommends amoxicillin prophylaxis. However, no systematic review of the literature of PJIs associated with dental procedures explores if amoxicillin is suitable for the reported organisms. Methods A librarian-assisted search of the major databases (PubMed, Medline, Embase, Scopus) identified 954 articles. Only case reports, case series, and reviews with patient level data were included. After exclusions, 79 articles were fully reviewed. Results Forty-four PJIs after dental procedures were identified, 22 in primary THA, 20 in primary TKA, one in revision THA, and one in a hip resurfacing procedure. Antibiotic prophylaxis was documented for 5 patients. The dental procedure was invasive in 35 (79.5%). Comorbidities were present in 17 patients (38.7%). The organisms reported were Streptococcus spp. in 44%, other aerobic gram-positives in 27%, anaerobic gram-positives in 18%, and gram-negative organisms in 11%. An estimated 46% of organisms may be resistant to amoxicillin. The outcomes of treatment were reported for 35 patients (79.5%). Twenty-seven patients (61.4%) had no clinical signs of PJI at the final follow-up visit. Conclusions Lower extremity PJI associated with dental procedures is often caused by organisms unlikely to be prevented with amoxicillin. Additional studies are warranted to determine the choice and efficacy of antibiotic prophylaxis to prevent dental-associated PJI in the highest risk patients. Insufficient data exist to recommend the optimal treatment for patients with PJI in THA and TKA associated with dental procedures.
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Affiliation(s)
| | - Anne M Lachiewicz
- Division of Infectious Diseases, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Karen D Barton
- Duke University Medical Center Library & Archives, Durham, NC, USA
| | - Paul F Lachiewicz
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA.,Durham Veteran's Administration Medical Center, Durham, NC, USA
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15
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Donkor ES, Kotey FCN. Methicillin-Resistant Staphylococcus aureus in the Oral Cavity: Implications for Antibiotic Prophylaxis and Surveillance. Infect Dis (Lond) 2020; 13:1178633720976581. [PMID: 33402829 PMCID: PMC7739134 DOI: 10.1177/1178633720976581] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
The oral cavity harbors a multitude of commensal flora, which may constitute a repository of antibiotic resistance determinants. In the oral cavity, bacteria form biofilms, and this facilitates the acquisition of antibiotic resistance genes through horizontal gene transfer. Recent reports indicate high methicillin-resistant Staphylococcus aureus (MRSA) carriage rates in the oral cavity. Establishment of MRSA in the mouth could be enhanced by the wide usage of antibiotic prophylaxis among at-risk dental procedure candidates. These changes in MRSA epidemiology have important implications for MRSA preventive strategies, clinical practice, as well as the methodological approaches to carriage studies of the organism.
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Affiliation(s)
- Eric S Donkor
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Fleischer CN Kotey
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Accra, Ghana
- FleRhoLife Research Consult, Teshie, Accra, Ghana
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16
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Motiani P, Chhabra V, Ahmad Z, Sharma PK, Gupta A. Risk Recognition and Multidisciplinary Approach for Non-Cardiac Surgeries in Paediatric Cardiac Patients: A Retrospective Observational Study. Cureus 2020; 12:e12030. [PMID: 33376661 PMCID: PMC7755101 DOI: 10.7759/cureus.12030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Congenital heart disease (CHD), a structural and functional heart disease, is the commonest birth defect with an incidence of one in 125 live births worldwide with ventricular septal defect (VSD), atrial septal defect (ASD) and tetralogy of Fallot (TOF) constituting the majority. Surgery for associated extra-cardiac anomalies (airway, skeletal, genitourinary, and gastrointestinal) may be required in 30% of these patients. Delivery of uneventful anaesthesia in these children requires an understanding of not only paediatric anaesthesia but also of the pathophysiology of the cardiac lesion and its associated risks. Aims The purpose of this retrospective review was to highlight the approach to the anaesthetic management and outcomes of patients with significant cardiac lesions presenting for non-cardiac surgeries. Material and methods A retrospective chart review of all children with congenital heart disease (CHD) (repaired or unrepaired) who were posted for a non-cardiac surgery in this tertiary care Paediatric super-specialty hospital from January 1, 2018 to December 31, 2019 was carried out. Data on demographics, peri-operative management, and clinical course was retrieved. Inclusion criteria were paediatric patients (0-18 years) of either gender with a diagnosis of a CHD (repaired or unrepaired) undergoing any non-cardiac surgeries (NCS) under anaesthesia/Monitored Anaesthesia Care (MAC). Exclusion criteria were procedures only under local anaesthesia (LA) or a minor procedure done solely under sedation not involving an anaesthesiologist. Results During the study period, we found five eligible cases who underwent a total of six procedures. Five procedures were elective and one was an emergency. Preoperative optimization was conducted by a multidisciplinary team including paediatric surgeons, anaesthesiologists, physicians, and cardio-thoracic surgeons. Anaesthesia was conducted by at least a consultant paediatric anaesthesiologist. Overall all patients tolerated anaesthesia well without any adverse events or complications. All six anaesthetic encounters were safe and uneventful.
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Affiliation(s)
- Poonam Motiani
- Paediatric Anaesthesia, Super Speciality Paediatric Hospital & Post Graduate Teaching Institute, Noida, IND
| | - Vibha Chhabra
- Paediatric Anaesthesia, Super Speciality Paediatric Hospital & Post Graduate Teaching Institute, Noida, IND
| | - Zainab Ahmad
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, IND
| | - Pramod K Sharma
- Paediatric Surgery, All India Institute of Medical Sciences, Bhopal, IND
| | - Anju Gupta
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, IND
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17
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Deniz-Sungur D, Aksel H, Karaismailoglu E, Sayin TC. The prescribing of antibiotics for endodontic infections by dentists in Turkey: a comprehensive survey. Int Endod J 2020; 53:1715-1727. [PMID: 32805741 DOI: 10.1111/iej.13390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/08/2023]
Abstract
AIM To investigate the antibiotic prescribing patterns for endodontic infections based on the reports of Turkish dentists. METHODOLOGY A survey consisting of 20 questions on general information and 13 questions on antibiotic prescribing patterns for endodontic cases was delivered to the e-mail addresses of general dentists and specialists via the database of the Turkish Dental Association. Collected data were analysed using Mc-Nemar-Bowker Test and multivariate ordinal logistic regression tests at the significance level of 0.05. RESULTS A total of 1007 responses were obtained from 17 827 dentists. The majority of the participants were general dental practitioners (GDP, 80%) whilst 8% were Endodontists. Gender, clinical experience, affiliations and speciality were significant risk factors for antibiotic prescription (P < 0.05). GDPs prescribed antibiotics twice as much as all specialists and members of public hospitals prescribed antibiotics three times more than specialists and clinical academics (P < 0.05). Amoxicillin with clavulanic acid was the most prescribed antibiotic (90%), followed by Ornidazole (25%). Clindamycin was the drug of choice for the patients with penicillin allergy (59%). Infection and fever control (76%), prophylaxis (44%) and avoiding swelling and trismus during endodontic treatment (26%) were the most common reasons for antibiotic prescriptions. Completing a course of prescribed antibiotics was recommended by most (75%). Infective endocarditis, immunosuppression, artificial heart valve and mitral valve prolapse were the main causes of prophylaxis in descending order. Uncontrolled and extensive use of antibiotics by patients (62%) was mentioned as the most effective reason for antibiotic resistance. Up to 10% of participants prescribed antibiotics for symptomatic irreversible pulpitis, asymptomatic apical periodontitis with or without endodontic treatment (8, 12 and 11%, respectively). Up to 20% of dentists prescribed antibiotics for symptomatic apical periodontitis when the pulp was vital or necrotic (13 and 23%, respectively). Almost one third of the participants prescribed antibiotics for symptomatic apical periodontitis of previously treated teeth with or without radiographic lesions whilst 34% prescribed antibiotics for acute apical abscess with localized swelling without systemic involvement. CONCLUSIONS The majority of dentists reported they prescribed antibiotics inappropriately. It is necessary to improve the knowledge of dentists about antibiotics and their indications in endodontics.
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Affiliation(s)
- D Deniz-Sungur
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - H Aksel
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.,Division of Endodontics, School of Dental Medicine, University at Buffalo, New York, USA
| | - E Karaismailoglu
- Department of Medical Informatics, University of Health Sciences, Ankara, Turkey
| | - T C Sayin
- Private Practice, Fort Lauderdale, Florida, USA
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18
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Discrepancy in Therapeutic and Prophylactic Antibiotic Prescribing in General Dentists and Maxillofacial Specialists in Australia. Antibiotics (Basel) 2020; 9:antibiotics9080492. [PMID: 32784644 PMCID: PMC7459474 DOI: 10.3390/antibiotics9080492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
There are concerns that general dentists (GDs) and dental specialists may be prescribing antibiotics inappropriately. This study explored the prescribing habits and decision-making processes of GDs versus oral and maxillofacial surgeons (OMFSs). A case-based online questionnaire was used to examine the prescribing of therapeutic and prophylactic antibiotics in two clinical scenarios. Stratified and systematic sampling strategies were implemented to provide a representative sample. The final valid sample was 60 GDs and 18 OMFSs. The majority of OMFSs (61.1%) routinely prescribed antibiotics for the surgical removal of third molars, which was significantly greater than for GDs (23.5%). For implant placement procedures, 72.2% of OMFSs and 62.1% of GDs prescribed antibiotics. Amoxicillin was the most selected agent for both scenarios. All OMFSs would prescribe antibiotic prophylaxis for patients with uncontrolled diabetes mellitus in both cases, but only 56.0–63.0% of GDs would do this. GDs based prescribing decisions primarily on information from prescribing guides, while OMFSs relied more on information gained from specialist training. Surgical prophylaxis protocols differed considerably between groups. Both groups used surgical prophylaxis for some situations that are outside current recommendations. Education with regards to discrepancies between clinical practice and current guidelines for antimicrobial therapy is needed to progress antimicrobial stewardship.
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19
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Abstract
Patients sometimes present to a medical practitioner with dental pain if they cannot see a dentist Doctors need to be aware of the common dental diseases that result in pain so they can help to manage the patient’s symptoms until they are able to see a dentist Appropriate advice regarding analgesics for dental pain is important. Paracetamol and ibuprofen are more effective in combination than either of them alone, with or without opioids Antibiotics are only indicated as an adjunct to dental treatment when there are signs of systemic involvement, progressive and rapid spread of infection, or when the patient is immunocompromised
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20
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Mende A, Venskutonis T, Mackeviciute M. Trends in Systemic Antibiotic Therapy of Endodontic Infections: a Survey among Dental Practitioners in Lithuania. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2020; 11:e2. [PMID: 32377326 PMCID: PMC7191382 DOI: 10.5037/jomr.2020.11102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/20/2020] [Indexed: 02/06/2023]
Abstract
Objectives Prescription trends to certain antibiotic classes in Lithuania have been observed. Considering the potential contribution to antimicrobial resistance and the evidence of inappropriate prescriptions highlights, the periodical assessment of antibiotic consumption trends is required. The aim of this study was to assess prescription behaviours of Lithuanian general dental practitioners concerning the systemic antibiotic therapy of endodontic infections. Material and Methods A sample of 198 Lithuanian dentists, registered on the database of the Lithuanian Dental Chamber, provided anonymous information about their clinical work by means of an online questionnaire. Results Among the participants, antibiotics were prescribed in less than 20% of endodontic cases. Most common diagnosis for the prescription was symptomatic apical periodontitis with periostitis (90%) and apical abscesses with systemic involvement (54%). Amoxicillin and co-amoxiclav were the preferred choices for the antimicrobial therapy. The preference of clavulanic acid combination over simple usage of amoxicillin is increasing relative to the participants age (P = 0.016) and working experience (P = 0.008). Clindamycin is prescribed in cases of allergy to beta-lactams. Practitioners with less years of clinical activity were more likely to prescribe antibiotics for spreading infections, than their associates with more than 10 years of practice (P < 0.001). Conclusions Clinicians of higher age were found to be more likely to prescribe broad-spectrum antibiotic combinations compared to their younger associates. The majority of practitioners were aware of the clinical recommendations.
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Affiliation(s)
- Alexander Mende
- Department of Dental and Oral Pathology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania
| | - Tadas Venskutonis
- Department of Dental and Oral Pathology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania
| | - Migle Mackeviciute
- Department of Dental and Oral Pathology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania
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21
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Savadi N, Barati O, Mirhadi H, Golkari A. Designing a customized clinical practice guideline regarding antibiotic prophylaxis for Iranian general dentists. BMC Oral Health 2019; 19:217. [PMID: 31590651 PMCID: PMC6781348 DOI: 10.1186/s12903-019-0905-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
Background Clinical practice guidelines produced by developed countries seemed to be not completely feasible for developing countries due to their different local context. In this study, we designed a customized guideline about antibiotic prophylaxis before dental procedures for Iranian general dentists. Methods This study was conducted of two parts, including a qualitative part and a cross-sectional analytic part. A multidisciplinary team searched for related guidelines and other documents, selected the most updated and high quality ones, customized their recommendations based on available antibiotics in Iran, prepared a draft adapted guideline and summarized its recommendations in 3 flowcharts. An expert panel (20 specialists of four Iranian dental universities) participated in a consensus process, afterwards to determine the relevance and clarity of the flowcharts and their items. Then the Content Validity Indices (CVIs) were calculated and any items with CVI higher than 0.79 remained. Results The adapted recommendations were summarized in flowcharts A to C. Two separate groups of patients who need antibiotic prophylaxis were presented in flowchart A; including those with high risk for distant-site infection (infective endocarditis and prosthetic joint infection) and those at risk for poor healing and orofacial infection (due to impaired immunologic function). Flowcharts B and C described antibiotic regimen and also the dental procedures where antibiotic prophylaxis was needed for mentioned groups. The content validity indices and the percentages of agreement between the expert panel members were considerably high. Conclusions A localized, clear and straight forward guideline that addresses all groups of dental patients who need antibiotic prophylaxis has been produced for Iranian general dentists. Supplementary information Supplementary information accompanies this paper at 10.1186/s12903-019-0905-3.
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Affiliation(s)
- Najmeh Savadi
- Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Ghasrdasht Street, Shiraz, 71956-15878, Iran.
| | - Omid Barati
- Education and Development Center, Health Human Resources Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Mirhadi
- Department of Endodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Golkari
- Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Ghasrdasht Street, Shiraz, 71956-15878, Iran
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22
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Tang M, Hu P, Wang CF, Yu CQ, Sheng J, Ma SJ. Prediction Model of Cardiac Risk for Dental Extraction in Elderly Patients with Cardiovascular Diseases. Gerontology 2019; 65:591-598. [PMID: 31048587 DOI: 10.1159/000497424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the rapidly increasing population of elderly people, dental extraction in elderly individuals with cardiovascular diseases (CVDs) has become quite common. The issue of how to assure the safety of elderly patients with CVDs undergoing dental extraction has perplexed dentists and internists for many years. And it is important to derive an appropriate risk prediction tool for this population. OBJECTIVES The aim of this retrospective, observational study was to establish and validate a prediction model based on the random forest (RF) algorithm for the risk of cardiac complications of dental extraction in elderly patients with CVDs. METHODS Between August 2017 and May 2018, a total of 603 patients who fulfilled the inclusion criteria were used to create a training set. An independent test set contained 230 patients between June 2018 and July 2018. Data regarding clinical parameters, laboratory tests, clinical examinations before dental extraction, and 1-week follow-up were retrieved. Predictors were identified by using logistic regression (LR) with penalized LASSO (least absolute shrinkage and selection operator) variable selection. Then, a prediction model was constructed based on the RF algorithm by using a 5-fold cross-validation method. RESULTS The training set, based on 603 participants, including 282 men and 321 women, had an average participant age of 72.38 ± 8.31 years. Using feature selection methods, 11 predictors for risk of cardiac complications were screened out. When the RF model was constructed, its overall classification accuracy was 0.82 at the optimal cutoff value of 18.5%. In comparison to the LR model, the RF model showed a superior predictive performance. The AUROC (area under the receiver operating characteristic curve) scores of the RF and LR models were 0.83 and 0.80, respectively, in the independent test set. The AUPRC (area under the precision-recall curve) scores of the RF and LR models were 0.56 and 0.35, respectively, in the independent test set. CONCLUSION The RF-based prediction model is expected to be applicable for preoperative clinical assessment for preventing cardiac complications in elderly patients with CVDs undergoing dental extraction. The findings may aid physicians and dentists in making more informed recommendations to prevent cardiac complications in this patient population.
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Affiliation(s)
- Min Tang
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Hu
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cao-Feng Wang
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuang-Qi Yu
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Sheng
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shao-Jun Ma
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
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23
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Porto Alegre UC, Cericato GO, Mario DAN, Fabris V. Conhecimento de cirurgiões dentistas sobre antimicrobianos e resistência bacteriana. JOURNAL OF ORAL INVESTIGATIONS 2019. [DOI: 10.18256/2238-510x.2019.v8i1.2909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Antimicrobianos são frequentemente prescritos por cirurgiões dentistas por razões terapêuticas e profiláticas para tratar infecções orofaciais. O uso inadequado e indiscriminado desses fármacos pode acarretar a seleção de microrganismos resistentes, gerando um problema de saúde pública. Pelo fato destes fármacos serem utilizados em todas as áreas da Odontologia, é indispensável que os cirurgiões dentistas tenham adequado conhecimentos a respeito dos antimicrobianos. Objetivo: verificar o nível de conhecimentos de cirurgiões dentistas sobre prescrição de antimicrobianos. Metodologia: foi aplicado questionário estruturado a 242 cirurgiões dentistas que atuam na cidade de Passo Fundo, Rio Grande do Sul, com questões demográficas e específicas sobre prescrição de antibacterianos. Os dados obtidos foram tabulados em uma planilha eletrônica do programa Excel e exportados para o programa estatístico StataSE 12 para a análise estatística. Resultados: dentre os entrevistados, aproximadamente 29% dos cirurgiões dentistas, utilizaram como critério de escolha de um antimicrobiano ser bactericida, e como método de se evitar a resistência bacteriana a maioria optou por receitar antimicrobiano apenas quando necessário. O medicamento de primeira escolha de, aproximadamente, 54% dos entrevistados foi a Amoxicilina e, para pacientes alérgicos a penicilina, a maioria utilizaria a Clindamicina. Conclusão: a partir da análise das respostas, pode-se concluir que cirurgiões dentistas possuem pouco conhecimento sobre antimicrobianos, bem como ações a serem realizadas para evitar a resistência bacteriana, sendo necessário uma melhora nos critérios do uso e prescrição de antimicrobianos e o estabelecimento de estratégias de educação continuada sobre este assunto com o objetivo de diminuir a incidência de problemas relacionados a prescrição desses medicamentos.
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24
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Lee RJ, Ratnayake J, Veerasamy A, Loch C, Cathro P, Brunton PA. Demographics, Practising Arrangements, and Standards: Survey among New Zealand Dentists. Int J Dent 2018; 2018:7675917. [PMID: 30581468 PMCID: PMC6276479 DOI: 10.1155/2018/7675917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/14/2018] [Accepted: 10/29/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To determine the demographic profile and practising arrangements of general dentists in New Zealand. METHODS A questionnaire comprising 19 sections with 125 questions was distributed via mail to 351 general dentists in New Zealand who were selected, at random, from the Dental Council of New Zealand's 2016 register. RESULTS Two hundred and four questionnaires were returned, of which 188 were usable giving a response rate of 53.5%. The majority of the respondents (63.5%) were male and practice principals (56.8%). Fifty-nine percent of the practices were located in city or town centres with a wide geographic distribution. Sole practitioners accounted for 24.1% of respondents, with the mean number of dentists per practice being 3.2. The majority of respondents (71.6%) attended five or more continuing professional development courses in the past year. Ninety-one percent of respondents used a computerized management system, and 95.3% used the Internet. The use of nickel-titanium endodontic files (83.9%) and digital imaging (82.2%) was the most frequently cited clinical innovations. Articaine was the most popular local anaesthetic of choice. CONCLUSIONS Dentistry is an ever-changing profession, with evidence that NZ dentists continue to develop, learn, and embrace advancements in technologies to supply high-quality evidence-based treatment.
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Affiliation(s)
- Robert James Lee
- University of Otago, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand
| | - Jithendra Ratnayake
- University of Otago, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand
| | - Arthi Veerasamy
- University of Otago, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand
| | - Carolina Loch
- University of Otago, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand
| | - Peter Cathro
- University of Otago, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand
| | - Paul A. Brunton
- University of Otago, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand
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25
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Affiliation(s)
- Paul Sambrook
- Chair, Dental Therapeutics Committee, Australian Dental Association, Sydney
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26
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Ierano C, Nankervis JAM, James R, Rajkhowa A, Peel T, Thursky K. Surgical antimicrobial prophylaxis. Aust Prescr 2017; 40:225-229. [PMID: 29377021 DOI: 10.18773/austprescr.2017.073] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Courtney Ierano
- National Centre for Antimicrobial Stewardship, Doherty Institute, Royal Melbourne Hospital/University of Melbourne
| | | | - Rod James
- National Centre for Antimicrobial Stewardship, Doherty Institute, Royal Melbourne Hospital/University of Melbourne
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship, Doherty Institute, Royal Melbourne Hospital/University of Melbourne
| | - Trisha Peel
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne
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