Dental Surgery - Guideline for Antimicrobial Prophylaxis and Prevention of Infection in

Publication: 06/03/2014  --
Last review: 24/09/2021  
Next review: 24/09/2024  
Clinical Guideline
CURRENT 
ID: 3729 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2021  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Please check the patients allergy status, as they may be allergic to Chlorhexidine, and alternative ( Providine iodine) solution will be required.
Be aware: Chlorhexidine is considered an environmental allergen.
Refer to the asepsis guidance.

GUIDELINE FOR ANTIMICROBIAL PROPHYLAXIS AND PREVENTION OF INFECTION IN DENTAL SURGERY
RECOMMENDED ROUTINE PROPHYLAXIS OPTIONS

Procedure or situation

Antimicrobial dose/route
Give within 1 hour of procedure starting unless otherwise stated1

Routine

MRSA Risk

Penicillin allergy

Periodontal surgery involving biomaterial grafts

2g Amoxicillin electronic Medicines Compendium information on Amoxicillinsingle oral dose

Clindamycin electronic Medicines Compendium information on Clindamycin 600mg or Doxycyline 200mg or Co-trimoxazole electronic Medicines Compendium information on Co-trimoxazole 960mg single oral dose
NB the effectiveness of these regimens has not been established in this context, counsel patient of the risks and benefits.

Clindamycin electronic Medicines Compendium information on Clindamycin600mg single oral dose

First stage bone augmentation pre-implant placement1

Single stage augmentation and implant placement1

Second stage dental implant placement after bone augmentation AND additional augmentation required1

Periodontal surgery NOT  involving biomaterial grafts

Not recommended

Not recommended

Not recommended

Dental implant placement without bone augmentation

Second stage dental implant placement after autogenous bone augmentation and NO additional augmentation required

OTHER MEASURES

Sources of infection implicated in surgical site infections include the microflora of the oral tissues and the peri-oral skin, instruments, the hands of the operator and assistant and the air of the surgery. 

The use of pre-operative measures to reduce the risk of surgical site infection at implant placement include the pre-operative use of an antiseptic mouthwash such as chlorhexidine2, which has been shown to decrease oral microflora load, and cleaning of the skin around the mouth and nose with antiseptic solution. However, Chlorhexidine is considered an environmental allergen and it should be omitted if the patient reports an allergy to Chlorhexidine. In such cases, alternative extra-oral skin preparation solution (Povidine Iodine) will be required. 

The standard aseptic technique adopted for all patients undergoing implant placement within the Leeds Dental Institute includes: 

  1. 0.2% Chlorhexidine Gluconate mouthwash for one minute pre-operatively2 
  2. Use of sterile gowns and surgical gloves for operators and assistants 
  3. Use of head covers for patient and staff 
  4. Use of masks for all staff 
  5. Use of sterilised instruments 
  6. Sterile drapes to cover the operating surfaces and the patient’s supine body 
  7. Cleaning of the peri-oral and peri-nasal tissues with Tisept (Chlorhexidine Gluconate 0.015% w/v and Cetrimide 0.15%)2 

Operators and assistants are trained in proper aseptic technique. Refer to the asepsis guidance.  

Sources of infection implicated in surgical site infections include the microflora of the oral tissues and the peri-oral skin, instruments, the hands of the operator and assistant and the air of the surgery.

The use of pre-operative measures to reduce the risk of surgical site infection at implant placement include the pre-operative use of an antiseptic mouthwash such as chlorhexidine2, which has been shown to decrease oral microflora load, and cleaning of the skin around the mouth and nose with antiseptic solution.
The standard aseptic technique adopted for all patients undergoing implant placement within the Leeds Dental Institute includes:

  1. 0.2% Chlorhexidine Gluconate mouthwash for one minute pre-operatively2
  2. Use of sterile gowns and surgical gloves for operators and assistants
  3. Use of head covers for patient and staff
  4. Use of masks for all staff
  5. Use of sterilised instruments
  6. Sterile drapes to cover the operating surfaces and the patient’s supine body
  7. Cleaning of the peri-oral and peri-nasal tissues with Tisept (Chlorhexidine Gluconate 0.015% w/v and Cetrimide 0.15%)2

Operators and assistants are trained in proper aseptic technique. Refer to the asepsis guidance.

FOOTNOTES

  1. As it is sometimes not possible to anticipate the need for bone augmentation, a pragmatic recommendation is therefore to give the recommended regimen as soon as possible after surgery.
  2. Be aware: Chlorhexidine is considered an environmental allergen. Please check the patient’s allergy status, as they may be allergic to Chlorhexidine. In this case, the pre-op mouth wash should be omitted and an alternative extra-oral skin preparation solution (Povidine Iodine) will be required.

Provenance

Record: 3729
Objective:
Clinical condition:
Target patient group:
Target professional group(s): Pharmacists
Secondary Care Doctors
Dental Staff
Adapted from:

Evidence base

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Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 2.0

Related information

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