Principle I: Procedure Should Have Significant Risk of Infection

Principle I: Procedure Should Have Significant Risk of Infection

For prophylactic antibiotics to reduce the incidence of infection, the surgical procedure must have a high enough incidence of infection to be reduced with antibiotic therapy. Clean sun.cry done with strict adherence to . basic surgical principles usually has an incidence of infection
of about 3%. Infection rates of 10% or more are usually considered unacceptable, and the use of prophylactic antibiotics must be strongly considered. For the dentist doing routine office surgery, this means that most office procedures performed on healthy patients do not require
prophylactic antibiotics. The incidence of infection after tooth extraction, frenectomy, biopsy, minor alveoloplasty, and torus reduction is extremely low; therefore antibiotics  would provide no benefit. • liowever, several surgical factors may influence the dentist to consider strongly the use of antibiotic prophylaxis (Box 15-9): The first and most obvious factor that may lead to infection is a bacterial inoculum of sufficient size. The
usual surgical procedure performed in the mouth rarely involves sufficient bacterial inoculation to cause infection. The second factor is surgical procedures that are rather extensive ami require prolonged surgery. The incidence of infection increases both with the extent of surgery and
with longer surgical procedures. A third factor that may suggest the use of antibiotics is the insertion or presenceof a foreign body, most commonly a dental implant. Most data seem to suggest that the use of antibiotics may
decrease the incidence of infection when foreign bodies, such as dental implants, are inserted into the jaws. The final and most important factor for most dentists in determining which patients should receive prophylactic
antibiotics is whether the patient has depressed host defenses. Patients who have a compromised ability to defend themselves against infection should probably receive prophylactic antibiotics because they are likely to have a higher incidence of more severe infection. All patients receiving cancer chemotherapy or  supressives should receive prophylactic antibiotics, even when minor surgical procedures are performed. Patientsreceiving immunosupprcsstves for organ transplant will be taking these drugs for the remainder of their lives and should be given preventive antibiotics accordingly. Patients receiving cancer chemotherapy will receive cytotoxic
drugs for 1 year or less but should be given prophylactic antibiotics for at least 1 year after the cessation of their chemotherapy.

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