Oral Medicine | Antibiotic Prophylaxis | INBDE

[@mentaldental]

UPDATE: According to the AHA May 2021 update, Clindamycin is now NO LONGER recommended for antibiotic prophylaxis for patients allergic to penicillin due to concerns over Clostridium difficile infection. Azithromycin is now the go-to alternative and this will be updated on the board exam to reflect that. The full article can be found here: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000969?fbclid=IwAR0coU1wmmfUcHEb-J5j3q8kbVUFJEFt1B5gHbnEzoK6o3BqDi7Anqt0454

[@garlysdaboin2829]

Thank you so much for doing this!

[@basimpeerzada6031]

does this also apply for NBDE part 2 exam?

[@salihayounis1508]

But clindamycin is still the answer for board exams that’s what teacher said in school

[@manishavidhani1116]

can we give same class of other drugs as prophylaxis like erythromycin as macrolide if azithromycin is not an option or should we choose clindamycin as alternative?

[@jpenaalberty]

I thought the to go alternative was Cephalexin 2mg for allergic pts

[@9411ak]

You have single-handedly saved me (and my classmates) from so much stress and anxiety during these crazy dental school years, You have honestly done so much good for the mental health of dental students everywhere, thank you Doc!

[@mentaldental]

Thank you for sharing, that is so great to hear! That is my exact purpose behind this channel 😁

[@kizzeekhan]

Hi Dr. Ryan. Just wanted to let you know your videos have been the primary source for my NBDE 2 preparation. I cannot thank you enough for all you have done for us. My exam is in a few days! I keep coming back to your videos for guidance. All your hard work is truly appreciated. May you have all the success and happiness in the world.

[@nnnnnnnn-b8v]

Much, much better explanation, attitude and enthusiasm to teach than UNIVERSITIES teachers I know…. Thank you for your honest help. 🙏

[@cutecathatesme336]

These videos are so important for clinic! I am a dentistry student my internship started and mostly the oral surgery professors ask about these ALL THE TIME. Thank you for this, it is so nice to see all these together with good explaining when before I had to just read from very long texts

[@arzuparajuli925]

Excuse me , are u an angel?? coz u make everything sound so easy peasy . thankyou for existing Dr.Ryan . God bless you .

[@rayyansameer99]

You're doing a great job Dr. Ryan the way you explain complicated concepts so easily and it remains retained in our memories after viewing your videos, thankyou so much!!!!

[@bmaybb3339]

I really don't know what to say but your channel is the best! Thank you so so much for the awesome content!

[@yosrasubhan5378]

Thank for everything and God bless you and make your wishes and dreams true... You are the best keep going .. you are helping and saving time for millions ...

[@kcmg20]

Hi Dr Ryan, thank you for this new series. I might not be able to watch the whole series since my exam is in a few days but still appreciate it. ❤️

[@harpreetrandhawa8958]

My favorites series !!! Thank you!!!! Thank you!!!!! You are my hero !!!

[@maprangpae2106]

Hello! Since I had commented in one of your video that i was gonna take an exam for Thailand national license, i now wanna tell you that i pass the exam already!! Thank you so much 😊

[@mentaldental]

Awesome! Congratulations!! 😁🙌🏼

[@maralmaadavaanyam5278]

Thank you for your information. Keep us updated

[@clairereilly1564]

Thank you for all of your videos! Really appreciate how concise you are with your material. I was curious though, why isn't there a video in this Oral Medicine series for renal disorders/medications? Thanks!

[@mentaldental]

You’re welcome! That content is included in my live class on Systemic Pathology. I gave that class last month on my website 😊

[@clairereilly1564]

@@mentaldental Cool! How do I access that class?

[@danielortiz7880]

Thank you Dr. Ryan ! I know this one will be very helpful for everyone. Your the best !

[@varunn4539]

Thanks Dr. Ryan! Your service to the dental posterity is greatly appreciated 🤘🏻👏🏻

[@kasbaghi6295]

You went above and beyond Dr Ryan👌🏻👌🏻👌🏻

[@dentaldmd3900]

Thank you doctor ryan this is amazing

[@harmandilshaad1467]

Dr. Ryan you and your team just fantastic. Thank you so much.

[@applebear311]

Thank you so much Dr Ryan,👏 my exam is this week and your videos have helped me to review all my concepts for the exam God Bless

[@mentaldental]

Wonderful! God bless you! 🙏🏼😄

[@harpreetrandhawa8958]

WOW !!! WHAT A OPENING !!! Just observed it !!!

[@mentaldental]

Glad you like it! 😁

[@Crowbit3]

God Bless you with these lessons!

[@grazielatorino16]

Thank you Dr. ! That is all what I need!!!

[@vanessaprincess2980]

Thank you for everything! Best videos! God bless you.

[@caridadmijares5038]

Excellent Material, accurate as always, an amazing job. Thank you so much Dr Ryan.

[@dinithiwickramathilaka8364]

Grateful as always 🌼

[@teethtales8604]

Interesting video, and an important topic!

[@elsakurian2045]

Thank you so much doc!!! These are such amazing resources to go through. You are the best!!!

[@mentaldental]

Glad you like them!

[@randomtoothguy]

Fantastic series Doc looking forward to more!

[@DrMemes-er2iv]

That opening blew me away 🤓🤓🤓

[@mentaldental]

I'm glad you enjoyed it! I'm pretty excited about it myself 🤩

[@ccmoon1995]

saaaame

[@jeeshriyarajan]

This is so clear. Thank you!!

[@lifeofhope5100]

very nice dr .ryan

[@LizHaggerty]

Life-saving video!

[@mentaldental]

Glad to hear that! 😊

[@zebanoor866]

Best teacher ❤ love🇮🇳

[@eddiesandoval6808]

Awesome video. Thank you so much! God Bless🙏🏽👍🏼❤️

[@AmitisL]

Very helpful, thank you

[@maryamnakisa]

great job dr!please looking forward,i habe my bord in next month:)

[@dr.future6230]

best channel ever

[@lora7677]

Thank you so much!!

[@carlaissaxxx]

Thank you for doing a comprehensive and updated explanation of these dental related topics. Very much helpful. Studying for the NDEB Canadian licensure🙋🏻‍♀️

[@hasankhalel8545]

I love it!!

[@jhouse9980]

So for the example where a patient is already taking Amoxicillin, wouldn't Clindamycin and Azithromycin be contraindicated? Since amoxicillin is bactericidal and macrolides and lincosamides are bacteriostatic.

[@mentaldental]

Good question. The ADA specifically recommends a lincosamide if someone is already on amoxicillin. The reason is, while technically their mechanisms compete with one another, a single dose designed for prophylaxis will not significantly interfere with the other antibiotic.

[@jhouse9980]

@@mentaldental That makes sense, thank you!

[@zaynabalaasam9417]

Thank you so much 💛💛

[@docadamwahby]

Love the new intro !!!

[@mentaldental]

Thanks!! 🤩

[@martongondim123]

Great video! tks

[@SKY-tg3fq]

Thank you!

[@duaaabubaker3673]

Really thanks 🎉

[@Leader9011]

Thanks alot for this video ...

[@dancindebs1]

Where do stents fall in premedication. Are they the same as shunts including reabsorbing ones. For bone marrow treatments for stem cell regeneration for hip regeneration instead of a complete hip replacement

[@heidarzandi2641]

Thank you a lot

[@HyndaviR]

If the patient has prosthetic valve condition and needs prophylaxis. Should we give prophylaxis for occlusal restoration involving clamping of rubber dam? Also should we prescribe antibiotics for root canal treatments....?

[@lifeofhope5100]

very good video...

[@mentaldental]

Thank you for the kind words! 😊

[@RockSimmer-gal4God]

I was taught that extraction is a dental protection but cleaning does as infection can be moved easily

[@Joe-nh8eq]

@17:50 but isn’t Z-pak static and therefore contraindicated with amox?

[@dancindebs1]

I had a complete hip replacement. My surgeon insisted I be pre medicated. I go to a dental school for treatment. They said the Pre med is not indicated. FTI.

[@estebancolina5505]

thanks doc!!!

[@hadeelmt7360]

Thank you so much. Can you study us immune, micro, oral histology?

[@spencerd.7502]

16:49 So are you saying just proceed with the EXT and have them take it after? If the two options were to have them take it and wait an hour then ext or proceed right away and have them take it within two hours what is more correct?

[@mentaldental]

Correct. In an ideal world, you would have them take the antibiotic and then wait an hour before proceeding, but this is often not feasible in practice especially if you have already scheduled back-to-back patients. Taking the antibiotic up to 2 hours afterward is more practical and still offers adequate coverage for the period of potential bacteremia.

[@vidyapatil9368]

For this question, a patient with multiple myeloma and a history of MI 7-10 Years with hypertrophic myocardial disease asked if needs antibiotics prophylaxis? Based on cardiac history we do not need it but, should we give antibiotic prophylaxis in immunocompromised patients with multiple myeloma. I am confused

[@anaisalonso2036]

Thank you so much for your videos. They are life saver. Should I watch this series of Oral Medicine if I'm taking NBDE part 2? Thank you

[@mentaldental]

You certainly can, but these topics tend not to be covered on the NBDE Part II!

[@abdullakhaled951]

For the last question, wasn’t joint(prosthetic) replacement fall under the “NO PROPHYLAXIS “.category? Then why should we prescribe an antibiotic?

[@mentaldental]

I described this earlier in the video. Rewind back to the first slide if you need the detailed explanation, but simply put, if an orthopedic surgeon is recommending antibiotics for a complex joint issue, it is not our place as dentists to override their medical recommendations and prescriptions.

[@puneetbhardwaj2083]

Thank u.. .. Pls upload more faster... M wating your video..

[@AhmedSa-g1f]

regarding the question about the pt already taking antibiotic for other reason and we give him another sort of antibiotic how can we know that high dose wont cause toxicity or damage to liver and kidney what is the standard here ?

[@selenalee7119]

Thank u

[@mentaldental]

You’re welcome! ☺️

[@rluo4529]

Wow love the new series! was wondering why placing orthodontic bands might require abx prophylaxis? and why wouldn't a local anesthetic injection that pierces the gingiva require it? Thank you!

[@mentaldental]

Good question. Placing orthodontic bands often causes significant gingival manipulation and bleeding hence the risk of a bacteremia event. Placing local anesthetic via a block or infiltration is of less risk due to the size and location of the puncture. The exception to that might be an intraligamental or PDL injection which I could argue would require prophylaxis in the appropriate patient.

[@JuliannaYee]

thank you Dr Ryan for your lecture! may I ask if antibiotic prophylaxis is required for the yes column to receive nonsurgical RCT?

[@Expert_S]

Ty

[@marinaharon]

Is Antibiotic prophylaxis a required for cardiac patients with pacemaker (according to the new statements)?

[@daniyalkhawarr]

Slight confusion related to the 'Other' table: Is it the case that prophylaxis will be given to patients that are eg. Severely immunocompromised, that are going through dental treatments that only qualify for Anti biotic prophylaxis? And if so - I am assuming that this prophylaxis is not necessarily for infective endocarditis, since there could be patients that are severely immunocompromised that would have a completely healthy heart and would not be at risk of infective endocarditis. Or is it so that individuals with a healthy heart but with immunodeficiency develop that risk?

[@daniyalkhawarr]

It is also mentioned that solid organ transplant recipients are eligible for antibiotic prophylaxis (which includes cardiac transplant) but previously it was mentioned that cardiac transplant recipients are only eligible incase of valvular regurgitation

[@numz87]

You mentioned if a patient is already taking amixicillin then we should give another class of drugs like azithromycin etc. But the ones you mentioned are bacteriostatic which amoxicillin is bactericidal so doesn't that cancel each other out?? What is your recommendation if such a question comes in the exam

[@amandamatsuhara1386]

Hi! Thank you so much for this video. You mentioned that patients already taking an antibiotic for an infection such as strep throat should take a different class of antibiotics if they need antibiotic prophylaxis. If patient is already taking amoxicillin for an infection and you give the patient Clindamycin isn't that an issue? I thought bacteriostatic and bactericidal drugs together end up being less effective?

[@apurvaraja8214]

This has already been asked and answered in the comments. Just scroll up :)

[@numz87]

Another question. Is antibiotic prophylaxis required for an rct, as it seems like uts invasive plus you will use a rubber dam clamp

[@tejasvimondreti4436]

Dear Dr.Ryan, In the first slide we learned that a joint replacement does not require Antibiotic prophylaxis. So, in one of the questions, where the Orthopedic surgeon recommends it for a prosthetic hip, should we still prescribe it? Thank you for your time.

[@mentaldental]

Refer to the last scenario in the Example Questions. There may be some situations where a patient had complications with their joint replacement. In these cases, prophylactic antibiotics may be considered after consultation with the patient and orthopedic surgeon. The chart at the beginning provides general guidelines, but there are almost always exceptions to the rule!

[@tejasvimondreti4436]

@@mentaldental thank you sir!

[@salihayounis1508]

Do we prescribe for root canal I know we do for surgical root canal

[@twincolima]

Dr. Ryan Thanks for the video! Do you have a reference for the indication of being able to take the antibiotic prophylaxis up to two hours after the procedure? Min 17:00. Thanks again

[@mentaldental]

That information is from the ADA website!

[@dr.luisdiaz5425]

Good afternoon Ryan , for a root canal with infection in a patient in the Yes side. Is it necessary antibiotic prophilaxys?

[@NourhenBrahem]

Any other conditions that you think you can include in this series?

[@mentaldental]

Good question! Do you have any suggestions?

[@NourhenBrahem]

@@mentaldental Rheumatoid arthritis for example?

[@wxy8941]

Fantastic... by the way, are there any pdf version exist of these videos?

[@mentaldental]

Yes! You can get them one of two ways. You can either sign up on my Patreon page for at least $10/month www.patreon.com/mentaldental or send $15 to me directly via PayPal (for the INBDE slides only) www.paypal.me/mentaldental

[@fastdentalbd1908]

Thanks a Lot Ryan. I am dr. saidur, a great fan of you From Bangladesh. I have a question, A patient taking Amoxycillin for the last 2 days and he/she is in the yes group. In that case , before going to extraction, should we give Prophylactic antibiotic dose beside that running dose? And how many days that previously running antibiotic course should run after procedure?

[@BibleTigrinya]

Can you help explain why we don’t give antibiotic prophylaxis on a Patient with Rheumatic heart disease? long-term prophylactic use of antibiotics reduces recurrence rate starting adulthood to life in this patients?Or is it b/c it has increased antibiotic resistance. Thanks for the video as always!

[@mentaldental]

The benefits do not outweigh the risks including development of antibiotic resistance.

[@nadiajelassi2759]

hello DR Rayan .. i have a concern about antibioprophylaxis given to a patient with valve replacement ... i some sources they say that if the valve replacement is there since more than 6 months then we don't need to prescribe atb prophylaxis .. i was confused .. is that right ?

[@James-pl4dw]

for Joint replacement is antibiotic prophylaxis required for impressions?

[@mentaldental]

That's a good question. Remember, for joint replacement, the general recommendation is no prophylactic antibiotics. However, when antibiotic prophylaxis is indicated given a patient's medical history, I would say not for alginate impressions, but I would if retraction cord is placed as part of the impression procedure.

[@asmasyed4677]

Dr Ryan, can you please explain, in the example question no2 you mentioned amox with azi (bactericidal and bacteriostatic drugs). Wont they cancel out eachothers effect? Thank you

[@ripankaur9255]

DEAR DOCTOR ,WOULD IT USEFUL FOR ADAT

[@dall289]

Hello, can I just ask you which books you usually use for reference? Thank you for explaining so beautifully

[@mentaldental]

This series is based mostly on Little and Falace's Dental Management of the Medically Compromised Patient: amzn.to/3ir2ozt

[@dall289]

@@mentaldental thank you so much 👍🏼

[@narimankarro5168]

Thank you doctor for all these amazing videos...do you think mental dental videos are enough to pass the inbde?..? ..specially i don’t have time to study from many sources!

[@mentaldental]

You're welcome! I think all of my videos are the highest yield source you can use to prepare for the exam, but I do recommend a few other resources that are available and listed on my Patreon page, so go check that out if you want the whole picture 😊 www.patreon.com/mentaldental

[@narimankarro5168]

Hello doctor..i want to thank you alot,,i passed my inbde few days ago and your videos were a key for this success ,,you are doing great..

[@narimankarro5168]

I wish i can find such amazing source for my toefl exam 😄😄😊

[@blahblabla4900]

@@narimankarro5168 how was it going? did you pass?

[@jayshreeram7140]

Hi, In dental decks 2017 it says that cardiac hypertrophy do require AB . I am preparing for NBDE part 2, in such contradictory answers what should I select in exam?

[@edisongonzalez8402]

Is this the only video on oral medicine or there are more to come?

[@mentaldental]

There are many more to come, this is just the first one!

[@AZS-pl4xc]

Hello.. Thank you very much for all of your very useful videos..⚘ Can you please guide me where I can study the latest guidelines for CPR?

[@mentaldental]

You don’t have to wait very long, the next video in the series will be on CPR!

[@AZS-pl4xc]

@@mentaldental really!

[@AZS-pl4xc]

@@mentaldental great! But my exam is in 10 days.. is the video going to be soon? Pleeeeeeeeeese

[@majdliaaudisho6238]

Hey Dr. Ryan, I'm confused of a question of prophylaxis in Successfully repaired Teratology of Fallot for an adult, do we have to give AB prophylaxis or no ?

[@mentaldental]

It's a debated topic, so I don't have a 100% clear answer for you... but here is my opinion. Unrepaired and partially repaired TOF would require prophylaxis. Successfully and completely repaired TOF would not.

[@majdliaaudisho6238]

@mentaldental I see, thank you, Dr. Ryan, I appreciate your response.

[@arlenysrodriguezbarrueta2410]

Hello dr Ryan. Thank you so much for all your excellent work helping us. I have a question. Do we need to give antibiotics prophylaxis for a pt with heart murmur? Thank you in advance.

[@mentaldental]

No you do not.

[@dentaldmd3900]

Doctor ryan thank you for all of your help. One question please, for the patients who are immune compromised like neutropenia, chemotherapy, radiotherapy, autoimmune diseases... do we prescribe them the antibiotic prophylaxis as we would for an infective endocarditis patient? (single dose 1 hour prior to therapy?)

[@mentaldental]

It would be the same dosage because it is given to prevent the same condition, infective endocarditis.

[@mariaestefaniaperez8504]

is this video updated to actual date 2023?

[@mentaldental]

Yes, the pinned comment in the comments section is updated to reflect new recommendations. Everything else is current in the video!

[@wiem3914]

thank you so much for your efforts and your work, İ have one question so after the procedure , will the patient continue taking ATB for three or four days or just before it and then stops? thank you so much

[@mentaldental]

Nope, it's only the one dose before the procedure for prophylaxis.

[@Jan-bc3ed]

Great video!! I have one question, I'm a bit confused about oral mucosa perforations. I thought giving an injection is a perforation to the mucosa... so in that case you would give antibiotic prophylaxis before a filling right (if giving local)?

[@mentaldental]

Technically a local anesthetic injection does perforate the mucosa, but the amount of trauma is negligible compared to the other examples like extraction and TAD placement that it does not qualify for antibiotic prophylaxis.

[@manalidesai4347]

hello can you provide ppt slides for lectures?

[@mentaldental]

You can get them one of two ways. You can either sign up on my Patreon page for at least $10/month www.patreon.com/mentaldental or send $15 to me directly via PayPal for the INBDE slides www.paypal.me/mentaldental

[@samarelbaz6841]

How rheumatic heart disease not indicated to antibiotic prophylaxis ?

[@mentaldental]

I don't have a good answer for exactly why, but it is no longer recommended since the risk for infective endocarditis in those conditions is negligible.

[@richelleesmillo3997]

Hi Doc Ryan, I've been very familiar in school with a table on prescriptions for atb prophylaxis that includes Cefazolin of Ceftriaxone 1gm IM or IV (50mg/kg IM or IV for children) for those unable to take oral meds AND are allergic to penicillins. Is this still correct? Hope you could answer this. Thanks a lot for all your videos btw!

[@bansaripatel7548]

I don’t think so it’s correct bcz those drugs are cephalosporins and if pt is allergic to penicillin then he or she must be allergic to cephalosporins as well as they are chemically same

[@A.H663]

Thanks Dr Ryan! Where can I get the slides for head and neck slide 6-20 , your patreon only has 1-6 .

[@mentaldental]

They are all uploaded there, check again!

[@niushar7095]

Thank you sooo much dear Dr. Ryan. Do we still need antibiotic for routine endodontic procedures? 😅 since it involves clamp

[@mentaldental]

Good question. We are entering some "gray area" with this scenario! If the rubber dam clamp is placed at the line angles of the tooth and does not disrupt the gingival tissue, then not needed--if however, you anticipate manipulation of the gingival tissues in properly placing the clamp, then antibiotic prophylaxis may be a good idea.

[@niushar7095]

@@mentaldental thank you so much for your response 🙏🏻