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Health Technology Assessment Fireside: Antibiotic Prophylaxis and Dental Treatment in Canada.

Brondani MA - J Pharm (Cairo) (2012)

Bottom Line: Results.Evidence-based clinical guidelines are yet to be seen.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 122/2199 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3.

ABSTRACT
Objectives. This paper discusses the controversies surrounding the antibiotic prophylaxis preceding dental interventions within the following research question: how effective is dental antibiotic prophylaxis in preventing comorbidity and complications in those at risk? Methods. A synthesis of the available literature regarding antibiotic prophylaxis in dentistry was conducted under the lenses of Kazanjian's framework for health technology assessment with a focus on economic concerns, population impact, social context, population at risk, and the effectiveness of the evidence to support its use. Results. The papers reviewed show that we have been using antibiotic prophylaxis without a clear and full understanding of its benefits. Although the first guideline for antibiotic prophylaxis was introduced in 1990, it has been revised on several occasions, from 1991 to 2011. Evidence-based clinical guidelines are yet to be seen. Conclusions. Any perceived potential benefit from administering antibiotic prophylaxis before dental procedures must be weighed against the known risks of lethal toxicity, allergy, and development, selection, and transmission of microbial resistance. The implications of guideline changes and lack of evidence for the full use of antibiotic prophylaxis for the teaching of dentistry have to be further discussed.

No MeSH data available.


Related in: MedlinePlus

Searching strategy using PubMed and inclusion and exclusion criteria for papers.
© Copyright Policy - open-access
Related In: Results  -  Collection


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fig1: Searching strategy using PubMed and inclusion and exclusion criteria for papers.

Mentions: Bacteria from the mouth can readily enter the bloodstream during daily oral hygiene activities like brushing and flossing (Table 1). The potential for bacteremia from dental procedures is more severe, however, especially when these procedures produce significant oral bleeding and/or exposure to potentially contaminated tissue such as during dental extractions, oral surgery, subgingival scaling and the subgingival placement of dental dam clamps, restorations or orthodontic bands. The bacteremia from daily oral hygiene and dental procedures does not cause harm to the majority of healthy individuals. However, those at risk of infection might develop health complications and thus might benefit from antibiotic prophylaxis. As per the population at risk from Kazanjian's framework, the author conducted a brief systematic review to discuss the guidelines used to inform dental practitioners on this health technology (HT) via PubMed using the key words “antibiotic prophylaxis” AND “dent∗” in titles, abstracts and text. 1037 results (paper titles) published since 1961 were found. A quick scan on the first 50 titles revealed that some were related to in vitro studies while others were in languages other than English. These 1037 titles were limited to “humans” and published in English, which lead to 886 titles: (((antibiotic prophylaxis) AND dent∗) AND human) AND English [Language], see Figure 1.


Health Technology Assessment Fireside: Antibiotic Prophylaxis and Dental Treatment in Canada.

Brondani MA - J Pharm (Cairo) (2012)

Searching strategy using PubMed and inclusion and exclusion criteria for papers.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4595935&req=5

fig1: Searching strategy using PubMed and inclusion and exclusion criteria for papers.
Mentions: Bacteria from the mouth can readily enter the bloodstream during daily oral hygiene activities like brushing and flossing (Table 1). The potential for bacteremia from dental procedures is more severe, however, especially when these procedures produce significant oral bleeding and/or exposure to potentially contaminated tissue such as during dental extractions, oral surgery, subgingival scaling and the subgingival placement of dental dam clamps, restorations or orthodontic bands. The bacteremia from daily oral hygiene and dental procedures does not cause harm to the majority of healthy individuals. However, those at risk of infection might develop health complications and thus might benefit from antibiotic prophylaxis. As per the population at risk from Kazanjian's framework, the author conducted a brief systematic review to discuss the guidelines used to inform dental practitioners on this health technology (HT) via PubMed using the key words “antibiotic prophylaxis” AND “dent∗” in titles, abstracts and text. 1037 results (paper titles) published since 1961 were found. A quick scan on the first 50 titles revealed that some were related to in vitro studies while others were in languages other than English. These 1037 titles were limited to “humans” and published in English, which lead to 886 titles: (((antibiotic prophylaxis) AND dent∗) AND human) AND English [Language], see Figure 1.

Bottom Line: Results.Evidence-based clinical guidelines are yet to be seen.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 122/2199 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3.

ABSTRACT
Objectives. This paper discusses the controversies surrounding the antibiotic prophylaxis preceding dental interventions within the following research question: how effective is dental antibiotic prophylaxis in preventing comorbidity and complications in those at risk? Methods. A synthesis of the available literature regarding antibiotic prophylaxis in dentistry was conducted under the lenses of Kazanjian's framework for health technology assessment with a focus on economic concerns, population impact, social context, population at risk, and the effectiveness of the evidence to support its use. Results. The papers reviewed show that we have been using antibiotic prophylaxis without a clear and full understanding of its benefits. Although the first guideline for antibiotic prophylaxis was introduced in 1990, it has been revised on several occasions, from 1991 to 2011. Evidence-based clinical guidelines are yet to be seen. Conclusions. Any perceived potential benefit from administering antibiotic prophylaxis before dental procedures must be weighed against the known risks of lethal toxicity, allergy, and development, selection, and transmission of microbial resistance. The implications of guideline changes and lack of evidence for the full use of antibiotic prophylaxis for the teaching of dentistry have to be further discussed.

No MeSH data available.


Related in: MedlinePlus