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Kamis, 05 November 2009

Dental Management of Patients With Moderate Risk Conditions

dentist
Medically compromised patients with moderate risk conditions include:
  • Patients with other uncorrected congenital cardiac malformations.
  • Patients with acquierd valvular dysfunction.
  • Patients with hypertrophic cardiomyopathy.
  • Patients with mitral valve prolapse with regurgitation.

Potential problems related to dental care:
  • Patients with these conditions are at moderate risk for bacterial endocarditis, secondary to dental treatment resulting in significant bleeding.
  • Patients with surgically repaired congenital defects without residual dysfunction do not require antibiotic prophylaxis.
  • Patients with a history of rheumatic fever but without evidence of rheumatic heart disease do not require antibiotic prophylaxis.
  • Patients with mitral valve prolapse without regurgitation do not require antibiotic prophylaxis.

Oral manifestation:
Ussually none

Prevention of problems:
Patients with moderate risk condition should receive prophylactic antibiotics before dental procedures likely to result in significant bleeding.

Treatment planning modifications:
  • Patients any of these conditions can receive any indicated dental care provided that prophylactic antibiotics are administered before those procedures likely to result in significant bleeding.
  • Dental treatment should be performed in each session during the 1-3 hours after administration of the antibiotics.
  • A second antibiotic dose may be indicated if the appoinment lasts more than 4-6 hours or if the multiple appointments occur on the same day.
  • Allow at least 9 days between treatment sessions so that penicillin-resistant organisms disappear from the oral flora. If treatment becomes necessary sooner than 9 days, select one of the alternative antibiotics for prophylaxis.

Source: Dental Management of the Medically Compromised Patient 6th Ed. (Little, J.W.; et al.)




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