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Ankylos Slide 2 Considerations of systemic disease in OMFS Slide 3 Rheumatic fever and rheumatic heart disease infective endocarditis (2g PC) Rheumatic fever and rheumatic heart disease infective endocarditis (2g PC) Congenital heart disease infective endocarditis, prolong bleeding time(thrombosis in small vessels) Congenital heart disease infective endocarditis, prolong bleeding time(thrombosis in small vessels) Surgical corrected cardiovascular lesions anticoagulant prolong bleeding time, endocarditis Surgical corrected cardiovascular lesions anticoagulant prolong bleeding time, endocarditis Slide 4 Considerations of systemic disease in OMFS Artificial heart valves anticoagulant prolong bleeding time, endocarditis Artificial heart valves anticoagulant prolong bleeding time, endocarditis Premedication : amoxicillin 2g, child 50mg/kg Premedication : amoxicillin 2g, child 50mg/kg Heart transplant : suppression of immune, anticoagulant, high steroid, may need supplementation Heart transplant : suppression of immune, anticoagulant, high steroid, may need supplementation Slide 5 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. 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. Slide 6 Table 5. Regimens for a Dental Procedure Situation Agent Regimen: Single Dose 30 to 60 min Before Procedure Table 5. Regimens for a Dental Procedure Situation Agent Regimen: Single Dose 30 to 60 min Before Procedure Adults Children Adults Children Oral Amoxicillin 2 g 50 mg/kg Unable to take oral medication Oral Amoxicillin 2 g 50 mg/kg Unable to take oral medication Ampicillin 2 g IM or IV 50 mg/kg IM or IV Cefazolin or ceftriaxone 1g IM or IV 50 mg/kg IM or IV Ampicillin 2 g IM or IV 50 mg/kg IM or IV Cefazolin or ceftriaxone 1g IM or IV 50 mg/kg IM or IV Allergic to penicillins or ampicillin oral Cephalexin* OR Clindamycin OR Azithromycin or clarithromycin 2 g 600 mg 500 mg 50 mg/kg 20 mg/kg 15 mg/kg Allergic to penicillins or ampicillin and unable to take oral medication Cefazolin or ceftriaxone OR Clindamycin 1 g IM or IV 600 mg IM or IV 50 mg/kg IM or IV 20 mg/kg IM or IV IM indicates intramuscular; IV, intravenous. *Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage. Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin. Allergic to penicillins or ampicillin oral Cephalexin* OR Clindamycin OR Azithromycin or clarithromycin 2 g 600 mg 500 mg 50 mg/kg 20 mg/kg 15 mg/kg Allergic to penicillins or ampicillin and unable to take oral medication Cefazolin or ceftriaxone OR Clindamycin 1 g IM or IV 600 mg IM or IV 50 mg/kg IM or IV 20 mg/kg IM or IV IM indicates intramuscular; IV, intravenous. *Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage. Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin. Slide 7 Considerations of systemic disease in OMFS Angina pectoris stress and anxiety, MI, sudden death nitroglycerin Myocardial infarction arrest, congestive heart failure, bleeding for anticoagulant, pacemaker cause infective endocarditis, >6month saver, morning, short visit, diazapam for stress, anticoagulant cause bleeding, no electric if pacemaker Slide 8 Arrythmia stress, cardiac arrest, pacemaker /no electric Arrythmia stress, cardiac arrest, pacemaker /no electric Congestive heart failure bleeding for thrombosis in vessels, CVA, short of breath, Congestive heart failure bleeding for thrombosis in vessels, CVA, short of breath, AIDS infection, bleeding AIDS infection, bleeding DM infection, poor wound healing, avoid hypoglycemia DM infection, poor wound healing, avoid hypoglycemia Slide 9 Considerations of systemic disease in OMFS Hyperthyroidism thyroid storm, avoid epinephrine Hypothyroidism hypothyroid coma, sensitive to narcotic, tranquilizer Anaphylaxis vital sign, epinephrine (Bosmin) to tongue Leukemia infection, bleeding, delayed healing Slide 10 Radiation mucositis, xerostomia, loss of taste, constricture of muscle, infection ( candida) sensitive of teeth, cervical caries, osteonecrosis, trismus Radiation mucositis, xerostomia, loss of taste, constricture of muscle, infection ( candida) sensitive of teeth, cervical caries, osteonecrosis, trismus Chemotherapy bleeding for bone marrow suppression, infection, anemia, leukopenia Chemotherapy bleeding for bone marrow suppression, infection, anemia, leukopenia Osteoporosis Foxamax BRONJ(bisphosphonte related osteonecrosis of jaws) Osteoporosis Foxamax BRONJ(bisphosphonte related osteonecrosis of jaws) Slide 11 Considerations of systemic disease in OMFS Chronic obstructive pulmonary disease (COPD) upright position, avoid bilateral mandibular or palatal block, avoid rubber dam, low flow O2, sedation with N2O+O2, if use steroid need supplementation Chronic obstructive pulmonary disease (COPD) upright position, avoid bilateral mandibular or palatal block, avoid rubber dam, low flow O2, sedation with N2O+O2, if use steroid need supplementation Osteoarthritis aspirin cause bleeding Osteoarthritis aspirin cause bleeding Slide 12 Considerations of systemic disease in OMFS Hypertension hypertension crisis, CVA, use 1:100000 epi, less than 3 cartridges Hypertension hypertension crisis, CVA, use 1:100000 epi, less than 3 cartridges Asthma avoid precipitating factors, bring inhaler, avoid aspirin, narcotic, NSAID, erythromycin (if take theophyllin) avoid sulfite-containing local, recent steroid need supplementation, stress free Asthma avoid precipitating factors, bring inhaler, avoid aspirin, narcotic, NSAID, erythromycin (if take theophyllin) avoid sulfite-containing local, recent steroid need supplementation, stress free Slide 13 Considerations of systemic disease in OMFS HBV contracted by dentist from infectious patient, most carrier are undetectable by history, all patients should be treated with strict aseptic approach Alcoholic liver disease bleeding tendencies Slide 14 Hemodialysis bleeding, hypertension, anemia, nephrotoxic drugs, AV shunt infection,hepatitis Hemodialysis bleeding, hypertension, anemia, nephrotoxic drugs, AV shunt infection,hepatitis Renal transplant steoid, infection due to immunosuppressive Renal transplant steoid, infection due to immunosuppressive Pregnancy and lactation radiation, drug, stress harm to fetus, supine hypotension, drug transmit by breast Pregnancy and lactation radiation, drug, stress harm to fetus, supine hypotension, drug transmit by breast Slide 15 Considerations of systemic disease in OMFS Rheumatoid arthritis (RA) bleeding for aspirin and NSAID,steroid usage Rheumatoid arthritis (RA) bleeding for aspirin and NSAID,steroid usage Stroke aspirin, coumarin cause bleeding, short appointment, check BP, minimum epi. Avoid epi. Cord Stroke aspirin, coumarin cause bleeding, short appointment, check BP, minimum epi. Avoid epi. Cord Adrenal insufficiency stress, delayed healing, infection, hypertension Adrenal insufficiency stress, delayed healing, infection, hypertension Slide 16 Thank for your attention