4. Clinical Guidelines for Liver Transplantation (PDF) - British ...

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Guidebook for the Solid Organ Transplant Programme Chapter 4 4.4.3 PROPHYLACTIC ANTIBIOTIC DENTAL COVERAGE As a general rule, we believe that all teeth should be preserved if at all possible. If this includes root canal or periodontal work, this should be done when the patient is well and ideally after transplantation. Pre-Transplant Patients These patients differ fundamentally from heart valve patients in two ways. The first is that it’s very easy to develop spontaneous bacterial peritonitis with dental procedures. Most of these patients will have ascites and therefore are at risk of this. The second problem is that because of their blood clotting abnormalities, things as simple as teeth cleaning can lead to progressive bleeding. Our major concern with cleaning and dental extractions, is that the patient will develop discomfort related to this and therefore will require some analgesia which could precipitate encephalopathy. Secondly, they can bleed from this and the swallowed blood and protein can also precipitate encephalopathy. Thirdly, they can become infected and not only can this also cause spontaneous bacterial peritonitis (SBP) but can also lead to encephalopathy. Therefore, as a general rule, patients and dental staff should follow these general guidelines. 1. Pre-transplant patients should generally not undergo either cleaning or any periodontal work unless they are very early in the course of their disease. The patient usually will be informed as to whether or not he/she could proceed with aggressive dental work. 2. Fillings above the gum line should be treated only with Amoxicillin 2 grams PO one hour prior to the dental procedure. 3. Fillings below the gum line, including root canals, should be performed in pre-transplant patients only when necessary. These patients should receive Amoxicillin 2 grams PO one hour before their dental procedure and Penicillin V 300 mg PO four times daily for four days. 4. Patients requiring standard extractions should receive Amoxicillin 2 grams PO one hour prior to dental procedures and Penicillin V 300 mg PO four times daily for ten days thereafter. 5. As mentioned above, we try to preserve every tooth. In the event that extraction is required of teeth 36, 37, 38, 46, 47 and 48, the addition of Decadron is usually of benefit. This helps to reduce swelling and therefore decreases analgesia requirement. The dosage is 4 mg on the morning of their procedure, 2 mg on the morning of post op day 1 and 1 mg on each of the subsequent two days. All of this of course is in addition to the Amoxicillin and Penicillin V as mentioned in number 4 above. 6. Patients who are allergic to Penicillin (non skin rash only) should receive a single dose of Clindamycin 600 mg PO instead of the 2 grams of Amoxicillin PO and should receive Clindamycin 300 mg PO three times a day instead of the Penicillin V. Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 21 See Page 1 for disclaimer
Guidebook for the Solid Organ Transplant Programme Chapter 4 4.4.3 PROPHYLACTIC ANTIBIOTIC DENTAL COVERAGE CONT. 7. Patients undergoing an elective root canal with localized abscesses should receive 48 hours of Penicillin V PO prior to their dental procedures at 300 mg four times a day which should then be continued for at least four days thereafter. Post Transplant Patients The American Heart Association Guidelines for the Prevention of Infective Endocarditis recommend antibiotic prophylaxis before dental procedures ONLY for patients who have a history of previous infective endocarditis, or who have had cardiac valve replacement, or surgically constructed pulmonary shunts, or conduits (1) . Prophylactic antibiotic coverage for dental procedures is recommended ONLY for the following transplant recipients: Prosthetic cardiac valve Previous infective endocarditis Congenital heart disease (CHD) Unrepaired cyanotic CHD months following repair of CHD with any prosthetic material or device Repaired CHD with residual defects Cardiac transplant recipients who develop cardiac valvulopathy Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 22 See Page 1 for disclaimer
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4. Clinical Guidelines for Liver Transplantation (PDF) - British ...

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