Dental antibiotic prophylaxis is the administration of antibiotics to a dental patient for prevention of harmful consequences of bacteremia that may be caused by invasion of the oral flora into an injured gingival or peri-apical vessel during dental treatment. This issue remains a subject under constant revision, with the intention of providing recommendations based on sound scientific evidence.

In the past, bacteremia caused by dental procedures (in most cases due to viridans streptococci, which reside in oral cavity), such as a cleaning or extraction of a tooth was thought to be more clinically significant than it actually was. However, it is important that a dentist or a dental hygienist be told of any heart problems before commencing treatment. Antibiotics are administered to patients with certain heart conditions as a precaution. Everyday tooth brushing and flossing will similarly cause bacteremia. Although there is little evidence to support antibiotic prophylaxis for dental treatment, the current AHA guidelines are highly accepted by clinicians and patients.Only a selected body of patients are categorized with a more significant risk of IE who might require antibiotic prophylaxis. These patients undergo non-routine management.

1. Prosthetic valves which include a transcatheter value, or those with prosthetic material used for cardiac valve repair
2. Previous incidence of IE
3. Congenital heart disease (CHD) - any type of cyanotic CHD, or any type of CHD repaired with a prosthetic material (via surgical or percutaneous techniques)
4. Up to 6 months after procedure or lifelong if residual shunt or valvular regurgitation remains
5. If no antibiotic cover is needed, manage the patient as if they were at normal risk of IE
6. If antibiotic cover is needed, discuss with the patient about pros & cons of antibiotic prophylaxis to obtain informed consent about their management.
7. Educate patient about the importance and relevance of good oral hygiene and infective endocarditis
8. Significance of adequate oral hygiene
9. Link between risk of IE & dental procedures or other invasive procedures
10. Identify & have awareness of early signs/symptoms of infective endocarditis
11. Know when to seek help/treatment when IE suspected
12. Review any patients with significant risk of IE if they develop a dental infection, and manage without delay to minimize risk of IE development.
13. Dental treatment commenced without antibiotic cover. Patients need to be informed regarding their cardiac condition and infective endocarditis, and how this may affect dental treatment.
14. Discussion of pros & cons of antibiotic prophylaxis, why it is not generally advocated
15. Significance of adequate oral hygiene
16. Link between risk of IE & dental procedures or other invasive procedures
17. Identify & have awareness of early signs/symptoms of infective endocarditis
18. Know when to seek help/treatment when IE suspected
19. If patients are insistent on antibiotic prophylaxis, consult the patient's cardiologist before proceeding. Preparing the tooth for placement of restorative material or materials, and
20. Placement of these materials.

Check patient's cardiac condition and determine whether they belong in the selected body of patients who are at a more significant risk of IE. If they do, the dentist should consult with the patient's cardiologist regarding antibiotic cover before dental treatment. Antibiotic cover is only considered when undergoing invasive dental procedures.The process of preparation usually involves cutting the tooth with a rotary dental hand piece and dental burrs or a dental laser to make space for the planned restorative materials and to remove any dental decay or portions of the tooth that are structurally unsound. If permanent restoration cannot be carried out immediately after tooth preparation, temporary restoration may be performed. The prepared tooth, ready for placement of restorative materials, is generally called a tooth preparation. Materials used may be gold, amalgam, dental composites, glass ionomer cement, or porcelain, among others. Preparations may be intracoronal or extra coronal. Intracoronal preparations are those which serve to hold restorative material within the confines of the structure of the crown of a tooth. Examples include all classes of cavity preparations for composite or amalgam as well as those for gold and porcelain inlays. Intracoronal preparations are also made as female recipients to receive the male components of Removable partial dentures. Extracoronal preparations provide a core or base upon which restorative material will be placed to bring the tooth back into a functional and aesthetic structure. Examples include crowns and on lays, as well as veneers.In preparing a tooth for a restoration, a number of considerations will determine the type and extent of the preparation. The most important factor to consider is decay. For the most part, the extent of the decay will define the extent of the preparation, and in turn, the subsequent method and appropriate materials for restoration.Another consideration is unsupported tooth structure. When preparing the tooth to receive a restoration, unsupported enamel is removed to allow for a more predictable restoration. While enamel is the hardest substance in the human body, it is particularly brittle, and unsupported enamel fractures easily. This technique involves placing a soft or malleable filling into the prepared tooth and building up the tooth. The material is then set hard and the tooth is restored. The advantage of direct restorations is that they usually set quickly and can be placed in a single procedure. The dentist has a variety of different filling options to choose from. A decision is usually made based on the location and severity of the associated cavity. Since the material is required to set while in contact with the tooth, limited energy (heat) is passed to the tooth from the setting process.

Manuscript submission for dental related issues are accepted, to know more about the journal https://www.omicsonline.org/oral-hygiene-and-health.php

Regards
Sarah eve

Editorial Assistant

Journal of Oral Hygiene and Health