Antimicrobial prophylaxis in oral surgery and dental procedures

Abstract

Transient bacteraemia is a known risk factor following oral surgery and invasive dental procedures in patients with altered immune system response and those with a susceptible site of infection (patients with heart valve prostheses or recent joint replacements, etc.) The most commonly isolated aerobic bacteria in postoperative bacteraemia are Streptococcus Viridans. However, other periodontal pathogenic anaerobic bacteria are found in up to 64% in blood cultures (mixed bacteria or anaerobic bacteria alone). Dental pathogenic bacteria do not appear to be covered by standard amoxicillin or clindamycin prophylactic regimens. This is partly due to the fact that these anaerobic bacteria often produce beta lactamase and also in view of results of antimicrobial sensitivity tests observed in recent studies. A personal history of exposure to dental pathogenic bacteria may have an impact on the patient s global health, not only because of classical local or systemic infectious complications, but also because dental pathogenic bacteria have been found in atheromatous plaques in coronary and carotid arteries. This finding, along with epidemiological data, suggests that such bacteria may contribute to the progression of vascular arteriosclerotic lesions and the occurrence of cardiovascular and/or cerebrovascular accidents, although the pathogenic mechanisms involved are not yet well known. Taking these facts into consideration, and in view of antimicrobial sensitivity data available at present, we believe that the use of amoxicillin/clavulanic acid is the most appropriate option for prophylaxis of all infectious risks associated with bacteraemia of oral origin, due to its broader cover of dental pathogenic bacteria and its pharmacokinetic profile.