%0 Journal Article
%T Health Technology Assessment Fireside: Antibiotic Prophylaxis and Dental Treatment in Canada
%A Mario A. Brondani
%J Journal of Pharmaceutics
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/365635
%X Objectives. This paper discusses the controversies surrounding the antibiotic prophylaxis preceding dental interventions within the following research question: how effective is dental antibiotic prophylaxis in preventing comorbidity and complications in those at risk? Methods. A synthesis of the available literature regarding antibiotic prophylaxis in dentistry was conducted under the lenses of Kazanjian¡¯s framework for health technology assessment with a focus on economic concerns, population impact, social context, population at risk, and the effectiveness of the evidence to support its use. Results. The papers reviewed show that we have been using antibiotic prophylaxis without a clear and full understanding of its benefits. Although the first guideline for antibiotic prophylaxis was introduced in 1990, it has been revised on several occasions, from 1991 to 2011. Evidence-based clinical guidelines are yet to be seen. Conclusions. Any perceived potential benefit from administering antibiotic prophylaxis before dental procedures must be weighed against the known risks of lethal toxicity, allergy, and development, selection, and transmission of microbial resistance. The implications of guideline changes and lack of evidence for the full use of antibiotic prophylaxis for the teaching of dentistry have to be further discussed. 1. Introduction Antibiotic prophylaxis is understood as a preventive health measure to minimize harmful interaction between the oral bacteria in the bloodstream with matrix molecules and platelets at body sites (e.g., organs, tissues), which could lead to generalized septicemia [1]. ¡°Because it is not possible to predict when a susceptible patient will develop an infection, prophylactic antibiotics are recommended when these patients undergo procedures that might produce bacteremia¡± [2]. A prophylactic antibiotic is then given prior to the dental procedure on the basis of its activity against oral bacteria, its toxicity, and its cost. This review paper discusses the controversies surrounding this prophylaxis as a health technology within the following research question: how effective is dental antibiotic prophylaxis in preventing comorbidity and complications in those at risk? In order to address this research question, a synthesis of the available literature on the issue under the lenses of Kazanjian¡¯s framework for health technology assessment (HTA) [3, 4] is performed. 2. The Framework for Health Technology Assessment In 2004, Kazanjian presented a framework for health technological decisions with the five overlapping components
%U http://www.hindawi.com/journals/jphar/2013/365635/