SBE prophylaxis

[scalpel2008]

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Finally, the AHA and the ADA have adopted guidelines that make a little more sense.

http://www.ada.org/prof/resources/topics/infective_endocarditis.asp

P.S. mods should post this in the residency forum also

 

[DrJeff]

All I can say is its about time they actually combined some logic with the science for the new guidelines after reading them.

Now the bigger issue is convincing all the patients who've been prophylaxed for years and years that they all of the sudden don't need to, and even a bigger challenge than that will be convincing their medical doctors about this🙄

 

[scalpel2008]

All I can say is its about time they actually combined some logic with the science for the new guidelines after reading them.

Now the bigger issue is convincing all the patients who've been prophylaxed for years and years that they all of the sudden don't need to, and even a bigger challenge than that will be convincing their medical doctors about this🙄

DrJeff, absolutely. I thought about that as well. I've had numerous patients who sit in the chair and the first thing they say is "i have a heart murmur and my doc said i need antibiotics before i see the dentist". I think that every PCP and cardiologist should document in the chart (for patients who had any of the previous "intermediate risk" conditions such as mitral regurg) that it was discussed with the patient that they do not require SBE prophylaxis for mucosal procedures. The dentist also has the responsibility to use SBE prophylaxis only when appropriate. I've had several patients who have told me that they were told that they had a murmur when they were an infant which went away but their other dentist always have them abx before a procedure (perhaps because of the "why not, it won't do any ahrm" attitude). It's awkward to let them know that they don't need it because essentially I'm telling them that their dentist doesn't know when to premedicate. Because I sure as hell am not going to give unnecessary abx and have them wait an hour just because it makes them feel more secure. I think that's taking the easy way out rather than educating the patient.

 

[DrJeff]

My real favorite prophylaxis scenario is when you've taken the time to explain to a patient the concept behind prophylaxis, and the European "models" where the incidence of prophylaxis is much less than in the U.S. (with the same occurrance rates of SBE also), and it all clicks with the patient about if they really need to take the pre-med. I've had a few ask me essentially why they only have to take the pre-med when they come to my office, but not when the floss or draw some of their own blood intra-orally on a potato chip or similar object. My answer to them, is in the incredibly unllikely event that they actually contracted SBE, if they were in my office just prior to that without pre-med, they could sue me, if they developed it as a result of a "flossing injury", they can't sue themselves

I honestly think that the biggest loosers in all of this, won't be patients, or won't some egos of our colleagues as we tactfully update them on current guidelines, by the pharmaceutical industry who will now be selling a whole lot less ABX each and every year.

 

[ItsGavinC]

I love the new AHA guidelines, especially where they (finally!) state that routinue home activities are more likely to cause SBE than are dental visits. Finally!!

But in reality most general dentists are going to phone the cardiologist, who will still probably have the pt. premed. It's all about CYA.

 

[DrJeff]

I love the new AHA guidelines, especially where they (finally!) state that routinue home activities are more likely to cause SBE than are dental visits. Finally!!

But in reality most general dentists are going to phone the cardiologist, who will still probably have the pt. premed. It's all about CYA.

Just think of the uproar this is going to cause all the medical board question writers. One of their favorite questions will be going away

 

[aphistis]

I love the new AHA guidelines, especially where they (finally!) state that routinue home activities are more likely to cause SBE than are dental visits. Finally!!

But in reality most general dentists are going to phone the cardiologist, who will still probably have the pt. premed. It's all about CYA.

I hate unnecessary premedication. There's a guy at IUSD who has literally tried to make me ask a physician's permission to do a routine filling on a valve replacement patient. Throwing these new recommendations at him is going to be a gratifying experience.

 

[ItsGavinC]

I hate unnecessary premedication. There's a guy at IUSD who has literally tried to make me ask a physician's permission to do a routine filling on a valve replacement patient. Throwing these new recommendations at him is going to be a gratifying experience.

I agree, but many of the old-timers are stuck in their ways and you'll probaby have to use a large elevator on them to get some movement from them.

In the case of the patient you mentioned, however, the AHA/ADA says that premed is still indicated in certain situations ("preventive antibiotics prior to a dental procedure are advised for patients with: artificial heart valves").

 

[jrd29]

In the case of the patient you mentioned, however, the AHA/ADA says that premed is still indicated in certain situations ("preventive antibiotics prior to a dental procedure are advised for patients with: artificial heart valves").

Though not needed on a "routine filling" where the injection is through non-infected tissue.

 

[loco81]

Hi guys , i just read this post and the ada's new guidelines . I 'll be taking part 2 soon so I was wondering if the exam questions should be answered based on 1997 or 2007 guidelines ?
what do you think ?

 

[scalpel2008]

Though not needed on a "routine filling" where the injection is through non-infected tissue.

the old guidelines stated what procedures need and what procedures don't need premed. The new guidelines leave some room for common sense and say "any procedure that will cause mucosal bleeding", and then they go on to say what procedures don't need it (and they don't include operative as not needing it unlike the 1997 guidelines). I would go with the "whatever causes mucosal bleeding" rule, even if it's a subgingival class 2 (not because i believe that will cause SBE but thats the new guideline and therefore medicolegal standard).