林聪胜中华民国口腔颚面外科专科医师高医口腔颚面外科硕士正安.ppt

Considerations of systemic disease in OMFS 林聰勝 Considerations of systemic disease in OMFS Rheumatic fever and rheumatic heart disease …infective endocarditis (2g PC) Congenital heart disease … infective endocarditis , prolong bleeding time(thrombosis in small vessels) Surgical corrected cardiovascular lesions …anticoagulant prolong bleeding time , endocarditis Considerations of systemic disease in OMFS Artificial heart valves …anticoagulant prolong bleeding time , endocarditis Premedication : amoxicillin 2g , child 50mg/kg Heart transplant : suppression of immune, anticoagulant, high steroid , may need supplementation AHA Prevention of Infective Endocarditis guideline(2007) Conclusions? The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations. Table 5. Regimens for a Dental Procedure Situation Agent Regimen: Single Dose 30 to 60 min Before Procedure