美國心臟學會(AHA)重新修訂牙科治療預防心內膜炎準則－矯正醫生的狂想曲--- Straight teeth and life

---AHA Updates Recommendations for Antibiotic Prophylaxis for dental procedures (http://dx.doi.org/10.1161/CIRCULATIONAHA.106.183095)

April 19 , 2007 AHA (American Heart Association) 美國心臟學會, 重新修訂牙科治療預防心內膜炎準則

全文刊登於Circulation Apr. 2007 期刊上 (http://dx.doi.org/10.1161/CIRCULATIONAHA.106.183095)

編撰團隊的主席為 Dr. Walter R. Wilson, MD, from Mayo Clinic in Rochester, Minnesota

AHA 上次修訂牙科治療預防心內膜炎準則 guidelines 是在 1997年.

為何新修訂抗生素預防心內膜炎準則updated guidelines ? 主要是研究顯示,

雖然某些牙科治療具高風險可致短暫的菌血症( transient bacteremia), 日常生活如咀嚼食物亦可能 (rates up to 51%).

刷牙及用牙線更高達68% (rates of transient bacteremia up to 68%)

因此,患者較易從日常活動得到心內膜炎(infective endocarditis, IE ) 而非牙科治療infrequent dental procedures.

---關於心內膜炎(infective endocarditis, IE )

牙科治療導致短暫的菌血症, 粗略估計在美國約一千四百萬分之一 . 其實微乎其微!

(1 case of infective endocarditis for every 14 million dental procedures).

心臟人工瓣膜患者, 約十一萬分之一. (1 case per 114,000 procedures)

曾有心內膜炎患者, 約九萬五千分之一. (1 case per 95,000 procedures )

因此, 此次AHA新修訂抗生素預防心內膜炎準則,

強調預防心內膜炎, 應該朝向加強改善患者口腔衛生及健康, 而不是抗生素的使用!!

"There should be a shift in emphasis away from a focus on a dental procedure and antibiotic prophylaxis

toward a greater emphasis on improved access to dental care and oral health in patients

with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis

and those conditions that predispose to the acquisition of infective endocarditis,"

PS. 遺憾的是, 目前大部份臺灣患者/家長聽不進去.

醫病關係緊張下, 醫師也不敢不開藥

----何種牙科治療需要使用抗生素預防心內膜炎?

**治療會侵入牙齦組織, 牙根尖部位, 或穿透口腔粘膜

IE prophylaxis is reasonable (Class IIb, level of evidence C) for dental procedures that

involve gingival tissues or the periapical region of a tooth

and for procedures that perforate the oral mucosa

--- 其他治療需要使用抗生素預防心內膜炎

Prophylactic antibiotics are necessary before gastrointestinal, genitourinary,

or skin procedures only if these locations have known infection.

----何種情況牙科治療需要使用抗生素預防心內膜炎?

In patients with cardiac conditions associated with the highest risk for adverse outcomes from IE:

prosthetic cardiac valve 心臟人工瓣膜
previous IE 曾有心內膜炎
unrepaired congenital heart disease (including palliative shunts and conduits) 未修復先天性心臟病
completely repaired congenital heart defect with prosthetic material or device, during the first 6 months after the procedure (修復先天性心臟病, 例如人工瓣膜, 未滿 6 個月)
repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or device
cardiac transplantation recipients who develop cardiac valvulopathy