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News Bulletin : ADA News Bulletin April 2011
39 APRIL 2011 feedback is no difference in risk between a single or multiple extractions. Bone suppression can be evaluated by the use of the fasted serum beta cross laps test (CTX). This is a simple cheap blood test that helps evaluate risk and allows for controlled drug holidays. Alternatively, empirical drug holidays can be employed. The New South Wales guidelines classify most patients on oral bisphosphonates as minimal risk who do not require any different management except consent. However, they do not discuss CTX or drug holidays but do differentiate treatment between whether one or more extractions are required. Antibiotic prophylaxis The principles of antibiotic prophylaxis are simple; a single high dose of an appropriate antibiotic for the type of bacterial contamination should be given just prior to the procedure. It was for this reason that Therapeutic Guidelines: Oral and Dental Version 1 recommended 2 grams of amoxicillin prior to extraction in patients on oral bisphosphonates. This is a regime familiar to all dentists. Although there are no large case controlled studies, the regime of CTX, drug holiday if indicated and a single antibiotic pre-operatively has been shown to be effective in small published studies. The New South Wales Antibiotic Proposals • These recommend five days of 6-hourly clindamycin prior to surgery and for five days after. • This is completely contrary to the principles of antibiotic prophylaxis. • At the time of surgery, by this regimen, there is only a low dose of antibiotic present rather than the high dose required. • Extended antibiotic treatment has an increased chance of microbial resistance developing. • The beta-lactam antibiotics, penicillin and amoxicillin, have an appropriate spectrum and although clindamycin is an effective agent against many oral organisms, it has a lesser scope. There is an increased risk of resistance in the use of clindamycin, particularly in patients with prior antibiotic exposure. There is documented morbidity associated with the use of clindamycin, particularly gastrointestinal in the elderly. • Compliance with this antibiotic regime must surely be an issue. The New South Wales regime requires patients to take 42 tablets over the ten days. Most patients with osteoporosis are elderly and many may be infirm and so lack of compliance and associated morbidity are likely to be significant. Conclusion The New South Wales Health Department Guidelines are significantly different from recognised International and Australian national guidelines. Since the New South Wales guidelines have now been in place for at least four years, audit mechanisms of the New South Wales Health Department should be able to demonstrate effectiveness and safety. However, unless such effectiveness and safety can be demonstrated, then the New South Wales Guidelines should be withdrawn and replaced by current International and Australian Guidelines. Michael McCullough Chairman Dental Therapeutics Committee Please refer to website www.racds.org for further details about the College and its programs ABOUT THE RACDS The College provides opportunities for new graduates and experienced dentists to improve their skills, knowledge, and understanding. Participation in College programs is suited to all career paths in Dentistry including private practice, government health services, academia, armed service, and university postgraduate study. Recognition of the College is widening as closer links and alliances are developed with agencies and institutions within Australia, New Zealand, Asia, the U.K, and the Middle East. General Stream MEMBERSHIP This two to three year, structured educational learning program for qualified General Dental Practitioners leads to the award of MRACDS. It is based on the successful completion of appropriate CPD courses and related RACDS assessment components. FELLOWSHIP The FRACDS General Stream comprises a Primary Examination and a Final Examination (holders of the award of MRACDS may present directly for the Final Examination). The Primary Program has six main areas of study and examination and the aim of the program is to enable candidates to demonstrate an understanding of fundamental principles of basic science and their relationship to clinical practice. The Final Examination is clinically oriented requiring demonstration of a broad experience in general dentistry, a maturity of clinical judgement and application of knowledge based on current literature. Special Field Stream MEMBERSHIP This pathway provides existing Fellows in the General Stream and potential Fellows in the Special Fields with the opportunity to become Members of the College in a specialist discipline. Membership is open to specialists in the fields of Dental Public Health, Endodontics, Oral Medicine, Periodontics, Prosthodontics, Special Needs Dentistry, Paediatric Dentistry, and Orthodontics (holders of the award of MRACDS in a Special Field may then apply for eligibility to present for the Final Examination in their Special Field). FELLOWSHIP Examinations at an advanced level in the Special Field Stream provide a pathway to Fellowship in the above specialist fields in addition to Oral and Maxillofacial Surgery. The College training program in Oral and Maxillofacial Surgery is accredited by, the Australian Medical Council, the Australian Dental Council and the Medical Council of New Zealand. Contact Us RACDS, Level 13, 37 York Street, Sydney, NSW 2000 AUSTRALIA Tel: +61 2 9262 6044 Fax: +61 2 9262 1974 Email: email@example.com Web: www.racds.org The Royal Australasian College of Dental Surgeons ABN 97 343 369 579 Oral and Maxillofacial Surgery Training Program Surgical Training Posts in Oral and Maxillofacial Surgery in Australia and New Zealand are accredited by the Royal Australasian College of Dental Surgeons as posts leading to Fellowship. Determination of eligibility for these posts, commencing 2012, is made on an Australia and New Zealand-wide basis by the RACDS. Application forms and guidance for potential applicants are available from the Registrar, RACDS, Lev 13, 37 York Street, Sydney NSW 2000, Australia; tel: +61(0)2 9262 6044; fax: +61(0)2 9262 1974; or email: firstname.lastname@example.org It must be noted that an interview in Sydney will be required for shortlisted applicants. Applications must be received by 20 May 2011. Separate applications will be necessary to the relevant employing authority for accredited positions which are available for 2012. This may involve responding to advertisements placed by employing authorities.
ADA News Bulletin March 2011
ADA News Bulletin May 2011