中华民国口腔颚面外科专科医师16张课件

1、林聰勝革民國腔顎一象面外科專科醫師口腔顎面外牙醫診所口外臨床指警師醫大口腔醫學院任助理教授Ankylos臺灣區教育訓練講師南台灣牙醫植體中华民国口腔颚面外科专科医师林聰勝革民國腔顎一象面外科專科醫師口腔顎面外牙醫診所口外臨床指警師醫大口腔醫學院任助理教授Ankylos臺灣區教育訓練講師南台灣牙醫植體Considerations of systemicdisease in OMFS林聰勝Considerations of systemic diseasein OMFsRheumatic fever and rheumatic heartdisease. infective endocarditi

2、s(2g PCCongenital heart disease . infectiveendocarditis, prolong bleedingtime(thrombosis in small vesselsSurgical corrected cardiovascularlesions. anticoagulant prolong bleedingtime, endocarditis林聰勝中华民国口腔颚面外科专科医师林聰勝Considerations of systemicdisease in OMFS林聰勝Considerations of systemicConsiderations

3、of systemic diseasein OMFsRheumatic fever and rheumatic heartdisease. infective endocarditis(2g PCCongenital heart disease . infectiveendocarditis, prolong bleedingtime(thrombosis in small vesselsSurgical corrected cardiovascularlesions. anticoagulant prolong bleedingtime, endocarditisConsiderations

4、 of systemic disConsiderations of systemic diseasein OMFsArtificial heart valves. anticoagulantprolong bleeding time, endocarditisPremedication amoxicillin 2g, child50mg/kgHeart transplant: suppression of immuneanticoagulant, high steroid, may needsupplementationConsiderations of systemic disAHA Pre

5、vention of InfectiveEndocarditis guideline(2007)Conclusions! The major changes in the updated recommendations include theCommittee concluded that only an extremely small number ofof infective endocarditis might be prevented by antibiotic prophyllprocedures even if such prophylactic therapy were 100%

6、 effective(2) Infectiveendocarditis prophylaxis for dental procedures is reasonable only for patients withlying cardiac conditions associated with the highest risk of adverse outcomedocarditis. (3) For patients with these underlying cardiac conditionsrophylaxis is reasonable for all dental procedure

7、s that involve manipulation ofngival 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 ofacquisition of infective endocarditis (5) Administration of antibiotics solely to preventendocarditis is not

8、 recommended for patients who undergo a genitourinary orgastrointestinal tract procedure. These changes are intended to define more clearlywhen infective endocarditis prophylaxis is or is not recommended and to providemore uniform and consistent global recommendationsAHA Prevention of InfectiveTable

9、 5. Regimens for a Dental Procedure Situation Agent RegimenSingle Dose 30 to 60 min Before ProcedureAdultsChildrenOral AmoxicillingUrable to take oral medication2 g IM or IV50mg/ kg IM orVCefazolin or ceftriaxone1 g IM orV50mg/ kg IM or IVAllergic to penicillins or ampicillinloral Cephalexin* OR Cli

10、ndamycinOR Azithromycin or clarithromycin 2 g 600 mg 500 mg 50 mg/kg 20mg/kg 15 mg/kg Allergic to penicillins or ampicillin and unable to takeoral medication Cefazolin or ceftriaxone OR Clindamycin 1 g IM or IV600 mg IM or IV 50 mg/kg IM or IV 20 mg/kg IM or IV IM indicatesintramuscular; IV, intrave

11、nous. *Or other first-or second-generation oralcephalosporin in equivalent adult or pediatric dosage. Cephalosporinsshould not be used in an individual with a history of anaphylaxis,angioedema, or urticaria with penicillins or ampicillinTable 5. Regimens for a DentalConsiderations of systemic diseas

12、ein OMFsAngina pectoris., stress and anxiety, MIsudden death., nitroglycerinMyocardial infarction . arrest, congestiveheart failure, bleeding for anticoagulantpacemaker cause infective endocarditis6month saver, morning, short visit,diazapam for stress, anticoagulant causebleeding, no electric if pac

13、emakerConsiderations of systemic disConsiderations of systemic diseasein OMFsArrythmia., stress, cardiac arrestpacemaker /no electricCongestive heart failure. bleeding forthrombosis in vessels, CVA. short ofbreathAIDS., infection, bleedingDM. infection, poor wound healingavoid hypoglycemiaConsiderat

14、ions of systemic disConsiderations of systemic diseasein OMFsHyperthyroidism ., thyroid storm, avoidepinephrineHypothyroidism. hypothyroid comasensitive to narcotic, tranquilizerAnaphylaxis. vital sign, epinephrine(Bosmin) to tongueLeukemia. infection, bleeding, delayedhealingConsiderations of systemic disConsiderations of systemic diseasein OMFsRadiation. mucositis xerostomia, loss oftaste, constricture of muscle, infection( candidasensitive of teeth cervical cariesosteonecrosis. trismusChemotherapy. . bleeding for bone marrowsuppression, infection,