1. 林聰勝 中華民國口腔顎面外科專科醫師 高醫口腔顎面外科碩士 正安牙醫診所 高醫口外臨床指導醫師 高醫大口腔醫學院兼任助理教授
Ankylos 臺灣區教育訓練講師
南台灣牙醫植體醫學會理事長

2. Considerations of systemic disease in OMFS
林聰勝

3. Considerations of systemic disease in OMFS
Rheumatic fever and rheumatic heart disease …infective endocarditis (2g PC)
Congenital heart disease … infective endocarditis , prolong bleeding time(thrombosis in small vessels)
Surgical corrected cardiovascular lesions …anticoagulant prolong bleeding time , endocarditis

4. Considerations of systemic disease in OMFS
Artificial heart valves …anticoagulant prolong bleeding time , endocarditis
Premedication : amoxicillin 2g , child 50mg/kg
Heart transplant : suppression of immune, anticoagulant, high steroid , may need supplementation

5. AHA Prevention of Infective Endocarditis guideline(2007)
Conclusionsﾑ The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.

6. Table 5. Regimens for a Dental Procedure Situation Agent Regimen: Single Dose 30 to 60 min Before Procedure
Adults Children
Oral Amoxicillin g mg/kg Unable to take oral medication
Ampicillin g IM or IV mg/kg IM or IV Cefazolin or ceftriaxone g IM or IV 50 mg/kg IM or IV
Allergic to penicillins or ampicillinﾑoral Cephalexin*  OR Clindamycin OR Azithromycin or clarithromycin 2 g 600 mg 500 mg 50 mg/kg 20 mg/kg 15 mg/kg Allergic to penicillins or ampicillin and unable to take oral medication Cefazolin or ceftriaxone  OR Clindamycin 1 g IM or IV 600 mg IM or IV 50 mg/kg IM or IV 20 mg/kg IM or IV IM indicates intramuscular; IV, intravenous. *Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage.  Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin.

7. Considerations of systemic disease in OMFS
Angina pectoris … stress and anxiety, MI, sudden death … nitroglycerin
Myocardial infarction … arrest, congestive heart failure, bleeding for anticoagulant, pacemaker cause infective endocarditis , >6month saver, morning, short visit, diazapam for stress, anticoagulant cause bleeding, no electric if pacemaker

8. Considerations of systemic disease in OMFS
Arrythmia … stress, cardiac arrest, pacemaker /no electric
Congestive heart failure … bleeding for thrombosis in vessels, CVA, short of breath,
AIDS … infection, bleeding
DM … infection, poor wound healing , avoid hypoglycemia

9. Considerations of systemic disease in OMFS
Hyperthyroidism … thyroid storm, avoid epinephrine
Hypothyroidism … hypothyroid coma , sensitive to narcotic, tranquilizer
Anaphylaxis … vital sign , epinephrine (Bosmin) to tongue
Leukemia … infection, bleeding, delayed healing

10. Considerations of systemic disease in OMFS
Radiation … mucositis , xerostomia , loss of taste, constricture of muscle , infection ( candida) sensitive of teeth , cervical caries , osteonecrosis , trismus
Chemotherapy … bleeding for bone marrow suppression , infection , anemia , leukopenia
Osteoporosis…Foxamax…BRONJ(bisphosphonte related osteonecrosis of jaws)

11. Considerations of systemic disease in OMFS
Chronic obstructive pulmonary disease (COPD) …upright position , avoid bilateral mandibular or palatal block, avoid rubber dam , low flow O2 , sedation with N2O+O2, if use steroid need supplementation
Osteoarthritis … aspirin cause bleeding

12. Considerations of systemic disease in OMFS
Hypertension … hypertension crisis, CVA, use 1: epi , less than 3 cartridges
Asthma … avoid precipitating factors, bring inhaler, avoid aspirin, narcotic, NSAID, erythromycin (if take theophyllin) avoid sulfite-containing local , recent steroid need supplementation , stress free

13. Considerations of systemic disease in OMFS
HBV …contracted by dentist from infectious patient, most carrier are undetectable by history, all patients should be treated with strict aseptic approach
Alcoholic liver disease … bleeding tendencies

14. Considerations of systemic disease in OMFS
Hemodialysis … bleeding , hypertension , anemia , nephrotoxic drugs , AV shunt infection ,hepatitis
Renal transplant …steoid, infection due to immunosuppressive
Pregnancy and lactation … radiation , drug, stress harm to fetus, supine hypotension , drug transmit by breast

15. Considerations of systemic disease in OMFS
Rheumatoid arthritis (RA) … bleeding for aspirin and NSAID ,steroid usage
Stroke … aspirin , coumarin cause bleeding , short appointment, check BP , minimum epi. Avoid epi. Cord
Adrenal insufficiency … stress, delayed healing , infection , hypertension

16. Thank for your attention