中华民国口腔颚面外科专科医师16张课件

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ConsiderationsofsystemicdiseaseinOMFS林聰勝ConsiderationsofsystemicdiseaseinOMFsRheumaticfeverandrheumaticheartdisease..infectiveendocarditis(2gPCCongenitalheartdisease..infectiveendocarditis,prolongbleedingtime(thrombosisinsmallvesselsSurgicalcorrectedcardiovascularlesions..anticoagulantprolongbleedingtime,endocarditis林聰勝中华民国口腔颚面外科专科医师林聰勝1ConsiderationsofsystemicdiseaseinOMFS林聰勝Considerationsofsystemic2ConsiderationsofsystemicdiseaseinOMFsRheumaticfeverandrheumaticheartdisease..infectiveendocarditis(2gPCCongenitalheartdisease..infectiveendocarditis,prolongbleedingtime(thrombosisinsmallvesselsSurgicalcorrectedcardiovascularlesions..anticoagulantprolongbleedingtime,endocarditisConsiderationsofsystemicdis3ConsiderationsofsystemicdiseaseinOMFsArtificialheartvalves..anticoagulantprolongbleedingtime,endocarditisPremedicationamoxicillin2g,child50mg/kgHearttransplant:suppressionofimmuneanticoagulant,highsteroid,mayneedsupplementationConsiderationsofsystemicdis4AHAPreventionofInfectiveEndocarditisguideline(2007)Conclusions!ThemajorchangesintheupdatedrecommendationsincludetheCommitteeconcludedthatonlyanextremelysmallnumberofofinfectiveendocarditismightbepreventedbyantibioticprophyllproceduresevenifsuchprophylactictherapywere100%effective(2)Infectiveendocarditisprophylaxisfordentalproceduresisreasonableonlyforpatientswithlyingcardiacconditionsassociatedwiththehighestriskofadverseoutcomedocarditis.(3)Forpatientswiththeseunderlyingcardiacconditionsrophylaxisisreasonableforalldentalproceduresthatinvolvemanipulationofngivaltissueortheperiapicalregionofteethorperforationoftheoralmucosa.(4)Prophylaxisisnotrecommendedbasedsolelyonanincreasedlifetimeriskofacquisitionofinfectiveendocarditis(5)Administrationofantibioticssolelytopreventendocarditisisnotrecommendedforpatientswhoundergoagenitourinaryorgastrointestinaltractprocedure.ThesechangesareintendedtodefinemoreclearlywheninfectiveendocarditisprophylaxisisorisnotrecommendedandtoprovidemoreuniformandconsistentglobalrecommendationsAHAPreventionofInfective5Table5.RegimensforaDentalProcedureSituationAgentRegimenSingleDose30to60minBeforeProcedureAdultsChildrenOralAmoxicillingUrabletotakeoralmedication2gIMorIV50mg/kgIMorⅣVCefazolinorceftriaxone1gIMorⅣV50mg/kgIMorIVAllergictopenicillinsorampicillinloralCephalexin*ORClindamycinORAzithromycinorclarithromycin2g600mg500mg50mg/kg20mg/kg15mg/kgAllergictopenicillinsorampicillinandunabletotakeoralmedicationCefazolinorceftriaxoneORClindamycin1gIMorIV600mgIMorIV50mg/kgIMorIV20mg/kgIMorIVIMindicatesintramuscular;IV,intravenous.*Orotherfirst-orsecond-generationoralcephalosporininequivalentadultorpediatricdosage.Cephalosporinsshouldnotbeusedinanindividualwithahistoryofanaphylaxis,angioedema,orurticariawithpenicillinsorampicillinTable5.RegimensforaDental6ConsiderationsofsystemicdiseaseinOMFsAnginapectoris.,stressandanxiety,MIsuddendeath.,nitroglycerinMyocardialinfarction..arrest,congestiveheartfailure,bleedingforanticoagulantpacemakercauseinfectiveendocarditis>6monthsaver,morning,shortvisit,diazapamforstress,anticoagulantcausebleeding,noelectricifpacemakerConsiderationsofsystemicdis7ConsiderationsofsystemicdiseaseinOMFsArrythmia.,stress,cardiacarrestpacemaker/noelectricCongestiveheartfailure..bleedingforthrombosisinvessels,CVA.shortofbreathAIDS.,infection,bleedingDM..infection,poorwoundhealingavoidhypoglycemiaConsiderationsofsystemicdis8ConsiderationsofsystemicdiseaseinOMFsHyperthyroidism.,thyroidstorm,avoidepinephrineHypothyroidism..hypothyroidcomasensitivetonarcotic,tranquilizerAnaphylaxis..vitalsign,epinephrine(Bosmin)totongueLeukemia.infection,bleeding,delayedhealingConsiderationsofsystemicdis9ConsiderationsofsystemicdiseaseinOMFsRadiation..mucositisxerostomia,lossoftaste,constrictureofmuscle,infection(candidasensitiveofteethcervicalcariesosteonecrosis.trismusChemotherapy..bleedingforbonemarrowsuppression,infection,anemia,leukopeniaOsteoporosis.FoXamax.BRONJ(bisphosphonterelatedosteonecrosisofjaws)Considerationsofsystemicdis10中华民国口腔颚面外科专科医师16张课件11中华民国口腔颚面外科专科医师16张课件12中华民国口腔颚面外科专科医师16张课件13中华民国口腔颚面外科专科医师16张课件14中华民国口腔颚面外科专科医师16张课件15中华民国口腔颚面外科专科医师16张课件16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ConsiderationsofsystemicdiseaseinOMFS林聰勝ConsiderationsofsystemicdiseaseinOMFsRheumaticfeverandrheumaticheartdisease..infectiveendocarditis(2gPCCongenitalheartdisease..infectiveendocarditis,prolongbleedingtime(thrombosisinsmallvesselsSurgicalcorrectedcardiovascularlesions..anticoagulantprolongbleedingtime,endocarditis林聰勝中华民国口腔颚面外科专科医师林聰勝17ConsiderationsofsystemicdiseaseinOMFS林聰勝Considerationsofsystemic18ConsiderationsofsystemicdiseaseinOMFsRheumaticfeverandrheumaticheartdisease..infectiveendocarditis(2gPCCongenitalheartdisease..infectiveendocarditis,prolongbleedingtime(thrombosisinsmallvesselsSurgicalcorrectedcardiovascularlesions..anticoagulantprolongbleedingtime,endocarditisConsiderationsofsystemicdis19ConsiderationsofsystemicdiseaseinOMFsArtificialheartvalves..anticoagulantprolongbleedingtime,endocarditisPremedicationamoxicillin2g,child50mg/kgHearttransplant:suppressionofimmuneanticoagulant,highsteroid,mayneedsupplementationConsiderationsofsystemicdis20AHAPreventionofInfectiveEndocarditisguideline(2007)Conclusions!ThemajorchangesintheupdatedrecommendationsincludetheCommitteeconcludedthatonlyanextremelysmallnumberofofinfectiveendocarditismightbepreventedbyantibioticprophyllproceduresevenifsuchprophylactictherapywere100%effective(2)Infectiveendocarditisprophylaxisfordentalproceduresisreasonableonlyforpatientswithlyingcardiacconditionsassociatedwiththehighestriskofadverseoutcomedocarditis.(3)Forpatientswiththeseunderlyingcardiacconditionsrophylaxisisreasonableforalldentalproceduresthatinvolvemanipulationofngivaltissueortheperiapicalregionofteethorperforationoftheoralmucosa.(4)Prophylaxisisnotrecommendedbasedsolelyonanincreasedlifetimeriskofacquisitionofinfectiveendocarditis(5)Administrationofantibioticssolelytopreventendocarditisisnotrecommendedforpatientswhoundergoagenitourinaryorgastrointestinaltractprocedure.ThesechangesareintendedtodefinemoreclearlywheninfectiveendocarditisprophylaxisisorisnotrecommendedandtoprovidemoreuniformandconsistentglobalrecommendationsAHAPreventionofInfective21Table5.RegimensforaDentalProcedureSituationAgentRegimenSingleDose30to60minBeforeProcedureAdultsChildrenOralAmoxicillingUrabletotakeoralmedication2gIMorIV50mg/kgIMorⅣVCefazolinorceftriaxone1gIMorⅣV50mg/kgIMorIVAllergictopenicillinsorampicillinloralCephalexin*ORClindamycinORAzithromycinorclarithromycin2g600mg500mg50mg/kg20mg/kg15mg/kgAllergictopenicillinsorampicillinandunabletotakeoralmedicationCefazolinorceftriaxoneORClindamycin1gIMorIV600mgIMorIV50mg/kgIMorIV20mg/kgIMorIVIMindicatesintramuscular;IV,intravenous.*Orotherfirst-orsecond-generationoralcephalosporininequivalentadultorpediatricdosage.Cephalosporinsshouldnotbeusedinanindividualwithahistoryofanaphylaxis,angioedema,orurticariawithpenicillinsorampicillinTable5.RegimensforaDental22ConsiderationsofsystemicdiseaseinOMFsAnginapectoris.,stressandanxiety,MIsuddendeath.,nitroglycerinMyocardialinfarction..arrest,congestiveheartfailure,bleedingforanticoagulantpacemakercauseinfectiveendocarditis>6monthsaver,morning,shortvisit,diazapamforstress,anticoagulantcausebleeding,noelectricifpacemakerConsiderationsofsystemicdis23ConsiderationsofsystemicdiseaseinOMFsArrythmia.,stress,cardiacarrestpacemaker/noelectricCongestiveheartfailure..bleedingforthrom