• American Academy of Pediatric Dentistry (AAPD). Clinical guideline on antibiotic prophylaxis for dental patients at risk for infection. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2005. 3 p. [6 references]

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

Bacteremia-induced infections following dental procedures

Management
Prevention
Treatment

Dentistry
Pediatrics

Dentists

To help practitioners make appropriate decisions regarding antibiotic prophylaxis for dental patients at risk

Pediatric patients with medical conditions that predispose them to bacteremia-induced infections following dental procedures, including patients with cardiac conditions, patients with compromised immunity, and patients with shunts, indwelling catheters, or medical devices

Antibiotic prophylaxis

• Amoxicillin
• Ampicillin
• Clindamycin
• Azithromycin
• Cefazolin

Incidence of bacteremia-induced infection

Searches of Electronic Databases

A MEDLINE search was performed using the keywords "subacute bacterial endocarditis," "bacteremia," "antibiotic prophylaxis," and "dental infection."

Not stated

Not stated

Not applicable

Review

Not stated

Expert Consensus

The oral health policies and clinical guidelines of the American Academy of Pediatric Dentistry (AAPD) are developed under the direction of the Board of Trustees, utilizing the resources and expertise of its membership operating through the Council on Clinical Affairs (CCA).

Proposals to develop or modify policies and guidelines may originate from 4 sources:

1. The officers or trustees acting at any meeting of the Board of Trustees
2. A council, committee, or task force in its report to the Board of Trustees
3. Any member of the AAPD acting through the Reference Committee hearing of the General Assembly at the Annual Session
4. Officers, trustees, council and committee chairs, or other participants at the AAPD's Annual Strategic Planning Session

Regardless of the source, proposals are considered carefully, and those deemed sufficiently meritorious by a majority vote of the Board of Trustees are referred to the CCA for development or review/revision.

Once a charge (directive from the Board of Trustees) for development or review/revision of an oral health policy or clinical guideline is sent to the CCA, it is assigned to 1 or more members of the CCA for completion. CCA members are instructed to follow the specified format for a policy or guideline. All oral health policies and clinical guidelines are based on 2 sources of evidence: (1) the scientific literature; and (2) experts in the field. Members may call upon any expert as a consultant to the council to provide expert opinion. The Council on Scientific Affairs provides input as to the scientific validity of a policy or guideline.

The CCA meets on an interim basis (midwinter) to discuss proposed oral health policies and clinical guidelines. Each new or reviewed/revised policy and guideline is reviewed, discussed, and confirmed by the entire council.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Once developed by the Council on Clinical Affairs (CCA), the proposed policy or guideline is submitted for the consideration of the Board of Trustees. While the board may request revision, in which case it is returned to the council for modification, once accepted by majority vote of the board, it is referred for Reference Committee hearing at the upcoming Annual Session. At the Reference Committee hearing, the membership may provide comment or suggestion for alteration of the document before presentation to the General Assembly. The final document then is presented for ratification by a majority vote of the membership present and voting at the General Assembly. If accepted by the General Assembly, either as proposed or as amended by that body, the document then becomes the official American Academy of Pediatric Dentistry (AAPD) oral health policy or clinical guideline for publication in the AAPD's Reference Manual and on the AAPD's Web site.

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.

Patients with Cardiac Conditions

Numerous cardiac conditions place patients at risk for endocarditis following dental manipulation. The American Academy of Pediatric Dentistry (AAPD) endorses the American Heart Association's (AHA) guideline on prevention of bacterial endocarditis. In addition to those diagnoses listed in the AHA guidelines, patients with a history of intravenous drug abuse and certain syndromes (e.g., Down, Marfan) may be at risk for developing bacterial endocarditis due to associated cardiac anomalies. The table below titled "Suggested Antibiotic Prophylactic Regimens," lists the suggested prophylaxis regimens.

Suggested Antibiotic Prophylactic Regimens*

*No second dose is recommended for any of these regimens. Adapted from: Dajani AS, Taubert KA, Wilson W, Bolger AF, et al. Prevention of bacterial endocarditis: Recommendations by the American Heart Association. JAMA. 1997;227:1794-1801.

Patients with Compromised Immunity

Patients with a compromised immune system may not be able to tolerate a transient bacteremia following invasive dental procedures. This category includes, but is not limited to, patients with the following conditions:

1. Human immunodeficiency virus (HIV)
2. Severe combined immunodeficiency syndrome (SCIDS)
3. Neutropenia
4. Immunosuppression
5. Sickle cell anemia
6. Status post splenectomy
7. Chronic steroid usage
8. Lupus erythematosus
9. Diabetes
10. Status post organ transplantation

Discussion of antibiotic prophylaxis for patients undergoing chemotherapy, irradiation, and hematopoietic cell transplantation appears in a separate AAPD guideline.

Patients with Shunts, Indwelling Vascular Catheters, or Medical Devices

Bacteremia following an invasive dental procedure may lead to colonization of shunts or indwelling vascular catheters. Vascular catheters, such as those required by patients undergoing dialysis, chemotherapy, or frequent administration of blood products, are susceptible to bacterial infections. Ventriculoatrial (VA) or ventriculovenus (VV) shunts for hydrocephalus are at risk of bacteremia-induced infections due to their vascular access. In contrast, ventriculoperitoneal (VP) shunts do not involve any vascular structures and, consequently, do not require antibiotic prophylaxis.

The AAPD endorses the recommendations of the American Dental Association and the American Academy of Orthopaedic Surgeons for management of patients with prosthetic joints. Antibiotic prophylaxis is not indicated for dental patients with pins, plates, and screws, nor is it indicated routinely for most dental patients with total joint replacements. Antibiotics may be considered when high-risk dental procedures (See table below titled "Dental Procedures Associated with Higher Incidence of Bacteremia") are performed for dental patients within 2 years following implant surgery or for patients who have had previous joint infections. Consultation with the child's physician may be necessary for management of patients with other implanted devices (e.g., Harrington rods, external fixation devices).

Dental Procedures Associated with Higher Incidence of Bacteremia

None provided

All oral health policies and clinical guidelines are based on 2 sources of evidence: (1) the scientific literature; and (2) experts in the field.

Prevention of post procedural bacteremia

Not stated

An implementation strategy was not provided.

Staying Healthy

Effectiveness

• American Academy of Pediatric Dentistry (AAPD). Clinical guideline on antibiotic prophylaxis for dental patients at risk for infection. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2005. 3 p. [6 references]

Not applicable: The guideline was not adapted from another source.

2002 (revised 2005)

American Academy of Pediatric Dentistry - Professional Association

American Academy of Pediatric Dentistry

Council on Clinical Affairs

Not stated

Not stated

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

None available

This NGC summary was completed by ECRI on August 18, 2005.

This summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.