Antimicrobial prophylaxis in dentistry

Surgical Site Infections Following Bimaxillary Orthognathic, Osseous Genioplasty, and Intranasal Surgery: A Retrospective Cohort Study

“…Orthognathic procedures are typically carried out through an intraoral approach and are classified as clean contaminated, with an expected infection rate as high as 10 to 15%. [31][32][33][34][35] Basic principles of antibiotic prophylaxis include 1) that the drug be distributed in the tissue and reach a therapeutic level before the procedure starts and 2) that the antibiotics be maintained for the shortest period after there is no longer a risk of introducing infection. 34 Reaching an optimum blood level just before the procedure starts in orthognathic surgery is routine, but the ''shortest period'' after which prophylaxis is no longer required and the preferred antibiotic to use remain unclear.…”

“…All oral wounds are considered ''clean contaminated,'' with a potential infection rate as high as 15%. [31][32][33][34][35][36][37][38] Antibiotic prophylaxis should provide adequate drug levels in the tissue before, during, and for the shortest possible time after surgery to lower the infection rate. 34 It is said that the incidence of infection in these circumstances can be decreased to as low as 1% with good surgical technique and appropriate use of prophylactic antibodies.…”

Infection Control in Dentistry and Drug-Resistant Infectious Agents: A Burning Issue. Part 1

“…Recently, to overcome the misuse and abuse of antibiotics in dentistry, different institutions and associations recommended a more restrictive antibiotic policy to improve treatment efficacy and decrease bacterial resistance. Specific guidelines have been published for implantology [17], endodontia [75], oral surgery [17], third molar extraction [76], and medically compromised patients [77] and to prevent infective endocarditis [78,79] or prosthetic joint infections [80].…”

“…Bearing in mind the higher risk of contamination of ambulatory surgical areas, above all during long surgeries (sinus lift, several implant placing, guided bone regeneration (GBR)) and in medically compromised patients, we cannot exclude that a part of implant failures is the result of a chain of personnel latent errors, including some improper antiseptic measures (not surgical hand hygiene, unsterile gloves, improper use of mask, contamination of operating surface or room air, unsterile barrier covering, lack of surgical guide disinfection and mouth rinses, suture contamination by perioral skin bacteria, among others), as far as untrained professional practice [17,41,42,44,126].…”

“…Here, we think it is important to update these conclusions in the light of the global, wide, and long-term abuse and misuse of antibiotics in dentistry and selective pressure on opportunistic bacteria by favoring potentially pathogenic strains [16,17]. In addition, the limited awareness on infection prevention guidelines and lapses and errors during infection prevention according to Centers for Disease Control and Prevention (CDC) dental guidelines [6,[8][9][10][11] sustain the evidence of possible reservoirs of ARIAs in humans (patient, dental staff) and in the environment (clinical contact surfaces (CCSs), dental instruments, and dental unit water lines (DUWLs)) and possible hazards in surgical dental setting.…”