Antibiotic Prophylaxis for the Medically Compromised Dental Implant Patient

The conditions and devices were (i) cardiac-native heart valve disease, prosthetic heart valves, and pacemakers; (ii) hip, knee, and shoulder prosthetic joints; (iii) renal dialysis shunts; (iv) cerebral fluid shunts; (v) vascular grafts; (vi) immunosuppression secondary to cancer and chemotherapy; (vii) insulin dependent (type 1) diabetes mellitus; and (viii) systemic lupus erythematosus. The focus should be directed towards daily, thorough oral hygiene to purposefully reduce chronic oral bacteremia.4 There is a lack of evidence regarding the benefits of prolonged antibiotic prescribing; however, there is a problem of identifying patients at high risk, and there is no well-defined list of dental procedures that increase the patient's inherent danger. [...]prospective, randomized placebo-controlled clinical trials are needed to guide clinicians in making confident antibiotic prescribing recommendations regarding which patients and implant procedures represent a significantly increased risk of distant site infections.4 Based on information currently available in the peer-reviewed literature, it would be incorrect to say that all medically compromised patients require postoperative antibiotic coverage for 7–10 d. Understanding the severity of a patient's compromised immune response will guide the need for postoperative antibiotic coverage and thus prevent some distant site infections. [...]ignoring the use of antibiotics 100% of the time would be negligent and may lead to poor clinical outcomes in some patients due to unnecessary infections.5 For the medically compromised patient, a consultation with the patient's physician is necessary to determine whether postoperative antibiotic prophylaxis is required to prevent a systemic infection from the proposed invasive dental implant procedure.