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Dental Management: High Risk Conditions Patient

Posted by drg. Ardyan Gilang Rahmadhan SKG. On 2:11 AM

High risk conditions patient in dental treatment include:

  • Prosthetic valves
  • Bacterial endocarditis history
  • Single Ventricel states
  • Great arteries' transposition
  • Tetralogy of fallot

In dental care procedure, patient with these condition have potential problem such as:
  • High risk of bacterial endocarditis secondary to dental treatment that resulting in significant bleeding. Patient that have had surgical repair to their heart could also have this risk.
  • Patients that have been using long term anticoagulant therapy are at high risk of excessive bleeding.
  • Patient with cyanosis may be prone to infection and have excessive bleeding.

Oral manifestation:
  • No oral manifestation for prosthetic valves or history of previous bacterial endocarditis patient.
  • Possible cyanotic appearance of oral mucosa for complex cyanotic congenital heart disease.
  • Patient with heart problem also have possibility to get hematologic abnormalities. This condition could manifest as petechiae or ecchymosis in oral mucosa.

Prevention procedure
  • Administration of prophylactic antibiotics before doing dental procedure that result in significant bleeding.
  • Standard: oral amoxicillin
  • Unable to take oral medications: IV or IM ampicillin
  • allergic to penicillin: oral clindamycin
  • Allergic to penicillin and unable to take oral medication: IV clindamycin

Treatment planning modification
  • Administration of prophylactic antibiotics 1-3 hours before procedures likely to result in significant bleeding.
  • Administration of second antibiotics if dental procedure take more than 4-6 hours or if multiple appointments occur on the same day.
  • Patients that using anticoagulants medication may need to alter it doses depending on the level of anticoagulation and the extent of planned dental procedure.
  • Take a break at least 9 days between dental treatment sessions so that penicillin-resistant organisms disapear from the oral flora. If treatment session must be done sooner than 9 days, select one of the alternative antibiotics for prophylaxis.


Dental Management Of The Medically Compromised Patient (Little, J.W.; et.al.)





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