Dental Prostheses Without Proper Care Can Lead to Serious Oral Damage

Dental prostheses are designed to restore function, aesthetics, and oral health, but when they are poorly fitted or inadequately maintained, they may become a significant source of chronic trauma and oral disease.

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Both fixed and removable dental prostheses can lead to painful, inflammatory, and potentially serious lesions affecting soft and hard tissues.

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Understanding which lesions are associated with each type of prosthesis is essential for early diagnosis, prevention, and appropriate clinical management.

✅ Etiology: Why Do Dental Prostheses Cause Oral Lesions?
The main etiological factors include:

▪️ Poor marginal adaptation
▪️ Overcontoured prosthetic surfaces
▪️ Incorrect occlusal contacts
▪️ Prosthetic instability or overextension
▪️ Inadequate oral hygiene
▪️ Long-term use without professional follow-up
👉 Chronic mechanical irritation remains the primary mechanism leading to tissue damage.

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✅ Lesions Caused by Poorly Fitted Fixed Dental Prostheses
Poorly adapted crowns, bridges, and implant-supported restorations can cause localized but progressive tissue damage.

Common lesions include:
▪️ Traumatic gingivitis caused by overhanging margins
▪️ Chronic periodontal inflammation due to plaque accumulation
▪️ Violation of the biologic width, leading to persistent bleeding and attachment loss
▪️ Gingival recession associated with improper emergence profiles
▪️ Secondary caries at restoration margins
▪️ Periapical lesions related to occlusal overload
▪️ Oral ulcerations caused by sharp or overcontoured prosthetic edges
👉 Poor marginal fit is a major risk factor for biological failure of fixed prostheses.

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✅ Lesions Caused by Poorly Fitted Removable or Complete Dentures
Ill-fitting removable partial dentures and complete dentures affect larger mucosal areas and are strongly associated with chronic inflammatory conditions.

Common lesions include:
▪️ Denture stomatitis, characterized by erythematous palatal mucosa
▪️ Traumatic ulcers due to instability or overextension
▪️ Epulis fissuratum caused by chronic flange irritation
▪️ Inflammatory papillary hyperplasia, especially in long-term denture wearers
▪️ Angular cheilitis, often related to reduced vertical dimension
▪️ Residual ridge resorption due to uneven force distribution
▪️ Denture-associated oral candidiasis, particularly in elderly or immunocompromised patients
👉 Continuous use of ill-fitting dentures significantly increases mucosal pathology risk.

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✅ Clinical Signs and Symptoms
Patients with prosthesis-related lesions may present with:

▪️ Persistent oral pain or discomfort
▪️ Erythema and swelling
▪️ Ulcerations that do not heal
▪️ Bleeding during brushing
▪️ Burning mouth sensation
▪️ Difficulty chewing or speaking
Early recognition is key to preventing progression.

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✅ Diagnosis
Diagnosis is based on:

▪️ Detailed clinical examination
▪️ Evaluation of prosthesis fit, contours, and occlusion
▪️ Assessment of oral hygiene status
▪️ In selected cases, biopsy to rule out dysplastic or malignant lesions

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✅ Treatment and Clinical Management
Management depends on lesion type and severity and may include:

▪️ Prosthesis adjustment or replacement
▪️ Removal of traumatic factors
▪️ Improvement of oral hygiene protocols
▪️ Topical antifungal therapy for denture-related candidiasis
▪️ Anti-inflammatory or protective agents
▪️ Temporary discontinuation of denture use in severe cases
Treating the lesion without correcting the prosthesis will lead to recurrence.

💬 Discussion
Poorly fitted dental prostheses remain a preventable cause of oral lesions. Fixed prostheses tend to cause localized periodontal and biological complications, while removable dentures are more frequently associated with extensive mucosal inflammation and chronic trauma.
Routine follow-up and patient education are essential to reduce long-term complications.

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🎯 Clinical Recommendations
▪️ Always evaluate prosthesis fit during recall visits
▪️ Educate patients on proper prosthesis hygiene
▪️ Replace or reline dentures periodically
▪️ Avoid prolonged use of unstable or damaged prostheses
▪️ Investigate non-healing lesions promptly

✍️ Conclusion
Dental prostheses should improve oral health—not compromise it. Poorly fitted fixed and removable prostheses can cause serious oral lesions if not properly designed, monitored, and maintained. Early intervention and regular professional care are essential to prevent long-term damage.

📚 References

✔ Budtz-Jørgensen, E. (1990). Oral mucosal lesions associated with the wearing of removable dentures. Journal of Oral Pathology & Medicine, 19(2), 65–70.
✔ Felton, D. (2016). Edentulism and comorbid factors. Journal of Prosthodontics, 25(Suppl 1), S2–S20.
✔ Goodacre, C. J., Bernal, G., Rungcharassaeng, K., & Kan, J. Y. (2003). Clinical complications in fixed prosthodontics. The Journal of Prosthetic Dentistry, 90(1), 31–41.
✔ Gendreau, L., & Loewy, Z. G. (2011). Epidemiology and etiology of denture stomatitis. Journal of Prosthodontics, 20(4), 251–260.
✔ Lang, N. P., & Berglundh, T. (2011). Periimplant diseases. Journal of Clinical Periodontology, 38(Suppl 11), 178–181.

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Congenital Syphilis: Dental Manifestations – Hutchinson Incisors and Mulberry Molars

Congenital syphilis remains a preventable yet clinically significant condition, with oral and dental findings that may serve as key diagnostic clues for dentists and pediatric specialists.

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Among the most characteristic features are Hutchinson incisors and mulberry (Moon) molars, which reflect systemic disruption during tooth development caused by Treponema pallidum infection.

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✅ Etiology and Routes of Transmission
Congenital syphilis is caused by vertical transmission of Treponema pallidum from an infected mother to the fetus. Transmission occurs primarily via:

▪️ Transplacental spread, especially after the first trimester
▪️ Untreated or inadequately treated maternal syphilis
▪️ Late prenatal diagnosis or absence of prenatal care
The risk of fetal infection increases with higher maternal spirochete load and earlier stages of maternal disease.

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✅ Pathogenesis of Dental Alterations
Dental manifestations result from chronic inflammatory damage to developing tooth germs, particularly during the bell and apposition stages of odontogenesis. The infection interferes with ameloblast and odontoblast function, leading to enamel hypoplasia and abnormal crown morphology.

✅ Key Dental Manifestations

➤ Hutchinson Incisors
▪️ Permanent maxillary central incisors
▪️ Screwdriver-shaped crowns
▪️ Notched or crescent-shaped incisal edges
▪️ Reduced mesiodistal width
These incisors are considered pathognomonic of congenital syphilis.

➤ Mulberry (Moon) Molars
▪️ Typically first permanent molars
▪️ Irregular occlusal anatomy with multiple rounded enamel nodules
▪️ Poor cusp definition and abnormal enamel texture
These features reflect impaired enamel mineralization during early childhood.

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✅ Associated Oral and Systemic Manifestations

In addition to dental anomalies, affected children may present with:
▪️ Enamel hypoplasia in other permanent teeth
▪️ Delayed tooth eruption
▪️ High caries susceptibility

Classically, dental findings are part of Hutchinson’s triad, which includes:
▪️ Interstitial keratitis
▪️ Sensorineural hearing loss
▪️ Dental anomalies

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✅ Clinical Diagnosis in Dentistry
Dentists play a critical role in detection, as dental signs often persist even after systemic disease resolution. Diagnosis is based on:

▪️ Characteristic dental morphology
▪️ Medical history suggestive of congenital infection
▪️ Serologic confirmation (VDRL, RPR, treponemal tests)
▪️ Interdisciplinary evaluation with pediatrics and infectious disease specialists

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✅ Treatment and Dental Management

Medical Treatment
▪️ Penicillin G remains the gold standard for treating congenital syphilis
▪️ Early treatment prevents systemic complications but does not reverse dental defects

Dental Management
▪️ Restorative rehabilitation (composites, crowns, veneers)
▪️ Preventive care to reduce caries risk
▪️ Long-term monitoring of occlusion and eruption

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💬 Discussion
Despite global prevention strategies, congenital syphilis is re-emerging in many regions, making dental recognition increasingly relevant. Hutchinson incisors and mulberry molars are permanent markers of early systemic disease, underscoring the dentist’s role in early identification, referral, and multidisciplinary care.

🎯 Clinical Recommendations
▪️ Carefully evaluate atypical enamel defects and tooth morphology
▪️ Include congenital infections in the differential diagnosis of enamel hypoplasia
▪️ Refer suspected cases for serologic testing
▪️ Provide long-term restorative and preventive dental care

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✍️ Conclusion
Dental manifestations of congenital syphilis are not merely cosmetic findings but critical diagnostic indicators. Recognizing Hutchinson incisors and mulberry molars allows dental professionals to contribute to early diagnosis, comprehensive patient care, and improved long-term outcomes. Dentistry plays a vital role in identifying systemic diseases through oral signs.

📚 References

✔ Centers for Disease Control and Prevention. (2023). Congenital syphilis – STI treatment guidelines. https://www.cdc.gov/std/treatment-guidelines/congenital-syphilis.htm
✔ Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2023). Oral and maxillofacial pathology (5th ed.). Elsevier.
✔ Shafer, W. G., Hine, M. K., & Levy, B. M. (2019). Shafer’s textbook of oral pathology (8th ed.). Elsevier India.
✔ World Health Organization. (2022). WHO guidelines for the treatment of Treponema pallidum (syphilis). https://www.who.int/publications/i/item/9789240051400

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Is Dental Amalgam Being Phased Out Worldwide?

Dental amalgam, historically known as “silver fillings”, has been used for over a century to restore carious teeth due to its durability and ease of use.

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However, concerns regarding mercury toxicity and environmental pollution have prompted regulatory action in many countries. As dental practice evolves, there is a clear global transition toward composite resins and glass ionomer cements as preferred restorative materials.

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✅ What Is Dental Amalgam?
Dental amalgam is an alloy containing elemental mercury (~50%) combined with silver, tin, copper, and other metals. Mercury acts as a binding agent, providing structural strength. Although research (including FDA and IADR assessments) acknowledges that amalgam is effective as a restorative material, environmental and potential health concerns have increasingly influenced policy decisions.

✅ Environmental and Public Health Concerns
Mercury from dental amalgam contributes to environmental pollution, especially during waste management and cremation processes, leading to bioaccumulation in water, soil, and food chains. As a result, international treaties and national regulations are phasing down or banning its use, emphasizing mercury-free alternatives.

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✅ Which Countries Have Restricted or Banned Dental Amalgam?
Many countries have taken explicit action:

▪️ European Union: The EU’s Mercury Regulation (amending EU 2017/852) will phase out dental amalgam use by January 1, 2025, with narrow exceptions for specific medical needs, and bans on export, import, and manufacture by mid-2026.
Link (EU Regulation): European Parliament & Council regulation on mercury-added products — Article 10 of EU 2017/852 (amended) https://eur-lex.europa.eu/eli/reg/2024/1849/oj
▪️ Peru: Fully banned the use of dental amalgam (Ministerial Resolution N° 859-2024-MINSA); mercury-free materials are prioritized, with very limited exceptions.
▪️ Switzerland, Liechtenstein, Iceland: Prohibit dental amalgam where mercury-free alternatives are feasible.
▪️ Japan, Bolivia, El Salvador, Paraguay, Guyana, Saint Lucia, Uruguay, Mozambique: Have withdrawn amalgam from public dental programs, effectively phasing out its use.
▪️ Senegal, Thailand, Uruguay: Are implementing programs to reduce dental mercury waste and phase down use in alignment with the Minamata Convention.
Some countries have not banned but severely restricted amalgam, especially for vulnerable populations (children under 15, pregnant or breastfeeding women) based on the Minamata Convention.

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✅ Dental Materials Transition: Composite and Glass Ionomer Systems
With stricter regulations, the dental profession is shifting toward mercury-free restorative materials:

▪️ Composite resins: Tooth-colored, adhesive materials suitable for most cavity classes.
▪️ Glass ionomer cements (GICs): Release fluoride and bond chemically to tooth structure, beneficial in high-caries risk patients.
▪️ Resin-modified glass ionomers: Combine the advantages of resin and glass ionomer chemistry for better strength and aesthetics.
These materials are increasingly supported by clinical evidence showing adequate performance and esthetics without mercury.

✅ Clinical Considerations
Dentists must balance:

▪️ Restoration longevity and function
▪️ Esthetic demands
▪️ Environmental and patient safety concerns
▪️ Local regulations on amalgam use
Patient-centered care now often prioritizes mercury-free options, with amalgam reserved only when clinically justified or permitted by specific regulations.

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💬 Discussion
The evolution of restorative dentistry reflects broader societal priorities toward environmental sustainability and patient safety. While amalgam has established a long clinical history, the availability of reliable alternatives and global regulatory momentum accelerate its decline. Dental professionals should adapt by enhancing skills in adhesive dentistry and advocating for environmentally responsible practices.

✍️ Conclusion
The phase-out of dental amalgam is advancing globally due to environmental and health concerns and international agreements such as the Minamata Convention. Dentists are increasingly transitioning to composite resins and glass ionomer systems. Understanding regulatory frameworks and material science will be essential for modern, sustainable dental practice.

🎯 Clinical Recommendations
▪️ Favor composite and glass ionomer restorations when clinically appropriate
▪️ Stay informed on national and international regulations
▪️ Educate patients on material choices and environmental impacts
▪️ Ensure compliance with amalgam separator and waste management protocols
▪️ Adopt minimally invasive caries management to reduce restorative needs

📊 Comparative Table: Dental Amalgam vs Mercury-Free Restorative Materials

Aspect	Advantages	Limitations
Durability	Proven long-term clinical track record	Contains mercury; environmental disposal issues
Esthetics	Excellent (tooth-colored composites)	Amalgam is metallic and visible
Biocompatibility	Mercury-free materials reduce patient concern	Composite may be technique-sensitive
Environmental Impact	No mercury-related pollution	Amalgam contributes to mercury waste
Fluoride Release	Glass ionomers release fluoride	Amalgam does not

📚 References

✔ IADR. (2025). Safety of Dental Amalgam and Mercury Policy Review. International Association for Dental Research.
✔ European Parliament & Council. (2024). Amendment to Mercury Regulation (EU 2017/852) — Dental Amalgam Provisions. EU Official Journal.
✔ EnvMed Network. (2025). Countries Phasing Out Dental Amalgam.
✔ Environmental Medicine. (2025). Global Dental Amalgam Tracker.
✔ Environmental and Health Perspectives. (n.d.). Mercury Contamination from Dental Amalgam.

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What Is Hairy Tongue and Why Does It Occur?

Hairy tongue (lingua villosa) is a benign and reversible oral condition characterized by elongation and hypertrophy of the filiform papillae on the dorsal surface of the tongue.

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This alteration leads to a hair-like appearance and may be associated with color changes ranging from white to brown or black. Although often alarming to patients, hairy tongue is non-malignant and usually asymptomatic, making proper diagnosis and patient education essential in dental practice.

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✅ Etiology
The condition results from defective desquamation of keratinized filiform papillae, allowing excessive keratin accumulation.

Common etiological factors include:
▪️ Poor oral hygiene
▪️ Smoking and tobacco use
▪️ Prolonged antibiotic therapy
▪️ Excessive coffee or tea consumption
▪️ Xerostomia
▪️ Soft or liquid diets
▪️ Use of oxidizing mouthwashes
Hairy tongue is considered a reactive condition, not a primary disease, and is often linked to lifestyle or medication-related factors.

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✅ Clinical Signs and Symptoms
Although many patients remain asymptomatic, clinical findings may include:

▪️ Hair-like projections on the dorsal tongue
▪️ Discoloration (black, brown, yellow, or white)
▪️ Halitosis
▪️ Dysgeusia (altered taste)
▪️ Gagging sensation or foreign body feeling
Pain is uncommon, and inflammation is typically absent.

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✅ Diagnosis
Diagnosis is primarily clinical, based on visual inspection. The elongated filiform papillae are easily identifiable, and biopsy is rarely indicated unless atypical features are present.

Differential diagnosis may include:
▪️ Oral candidiasis
▪️ Oral hairy leukoplakia
▪️ Pigmented tongue lesions

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✅ Treatment and Management
Hairy tongue management focuses on eliminating predisposing factors rather than pharmacological intervention.

Recommended treatments include:
▪️ Improved oral hygiene practices
▪️ Mechanical tongue cleaning with a brush or scraper
▪️ Smoking cessation
▪️ Discontinuation or modification of causative medications (when possible)
▪️ Increased hydration
Antifungal therapy is not routinely indicated unless secondary candidiasis is confirmed.

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✅ Hairy Tongue in Pediatric Patients
Hairy tongue is rare in children, but cases have been reported, often associated with antibiotic use or poor oral hygiene. Pediatric presentations tend to be milder and resolve rapidly with conservative measures.

📊 Comparative Table: Hairy Tongue Characteristics in Children

Aspect	Advantages	Limitations
Clinical Presentation	Usually mild and asymptomatic	May be confused with fungal infections
Etiological Factors	Often related to antibiotic use or hygiene habits	Less documented than adult cases
Treatment Response	Rapid resolution with conservative care	Requires parental compliance
Prognosis	Excellent with no long-term effects	Recurrence possible if risk factors persist

💬 Discussion
Despite its striking appearance, hairy tongue is a harmless condition with no malignant potential. Misdiagnosis may lead to unnecessary antifungal or antibiotic therapy. Dental professionals play a crucial role in reassuring patients, identifying contributing factors, and promoting effective oral hygiene practices.

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🎯 Clinical Recommendations
▪️ Educate patients about the benign nature of hairy tongue
▪️ Encourage daily tongue cleaning as part of oral hygiene
▪️ Assess medication history, especially recent antibiotic use
▪️ Avoid unnecessary pharmacological treatments
▪️ Monitor for resolution and reassess if lesions persist

✍️ Conclusion
Hairy tongue is a benign, reversible oral condition caused by impaired desquamation of filiform papillae. Early recognition and conservative management are usually sufficient. Through patient education and risk factor control, dentists can effectively manage this condition and prevent recurrence.

📚 References

✔ Gurvits, G. E., & Tan, A. (2014). Black hairy tongue syndrome. World Journal of Gastroenterology, 20(31), 10845–10850. https://doi.org/10.3748/wjg.v20.i31.10845
✔ Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2016). Oral and maxillofacial pathology (4th ed.). Elsevier.
✔ Houghton, J., & McCullough, M. J. (2017). Oral conditions associated with antibiotic use. Australian Dental Journal, 62(3), 309–315. https://doi.org/10.1111/adj.12524

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Antibiotic Prophylaxis Before Dental Procedures: Risks, Benefits, and Clinical Recommendations

Antibiotic prophylaxis before dental procedures has long been used to prevent infective endocarditis and other systemic complications associated with transient bacteremia.

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However, evolving scientific evidence and global concerns regarding antimicrobial resistance have significantly narrowed its indications. Today, prophylactic antibiotics are reserved for high-risk patients, emphasizing a more judicious, evidence-based approach in dental practice.

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✅ Rationale for Antibiotic Prophylaxis in Dentistry
Dental procedures that involve gingival manipulation or perforation of oral mucosa can cause transient bacteremia. In susceptible individuals, these microorganisms may colonize distant sites, particularly damaged cardiac tissues or prosthetic devices.

Key rationale includes:
▪️ Prevention of infective endocarditis in high-risk cardiac patients
▪️ Reduction of systemic infection risk in severely immunocompromised individuals
▪️ Protection of certain prosthetic or surgically placed medical devices (in limited scenarios)

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✅ Clinical Indications
According to current international guidelines, antibiotic prophylaxis is not routinely recommended for most dental patients.

Prophylaxis is indicated primarily for:
▪️ Patients with prosthetic heart valves
▪️ History of infective endocarditis
▪️ Certain congenital heart diseases
▪️ Cardiac transplant recipients with valvular disease
Routine dental procedures in healthy individuals do not justify antibiotic prophylaxis.

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✅ Benefits of Antibiotic Prophylaxis
When correctly prescribed, prophylaxis may provide targeted protection for vulnerable patients.

Documented benefits include:
▪️ Reduced risk of infective endocarditis in high-risk populations
▪️ Prevention of severe, potentially life-threatening complications
▪️ Short-term bacterial suppression during invasive dental procedures

✅ Risks and Limitations
The indiscriminate use of antibiotics poses significant clinical and public health concerns.

Major risks include:
▪️ Development of antimicrobial resistance
▪️ Adverse drug reactions, ranging from gastrointestinal symptoms to anaphylaxis
▪️ Alteration of normal oral and gut microbiota
▪️ False sense of security leading to neglect of optimal oral hygiene

📊 Comparative Table: Antibiotic Prophylaxis Before Dental Procedures

Aspect	Advantages	Limitations
Infective Endocarditis Prevention	Reduces risk in high-risk cardiac patients	No proven benefit in low-risk individuals
Antimicrobial Effect	Short-term suppression of bacteremia	Transient effect; does not replace oral hygiene
Patient Safety	Protects medically compromised patients	Risk of allergic reactions and side effects
Public Health Impact	Targeted use limits unnecessary exposure	Overuse contributes to antibiotic resistance

💬 Discussion
Modern dentistry has shifted toward a restrictive and evidence-based model of antibiotic prophylaxis. Large epidemiological studies suggest that daily activities such as tooth brushing may cause bacteremia levels comparable to dental procedures. Consequently, maintaining optimal oral health plays a more critical role in systemic infection prevention than prophylactic antibiotics for the general population.
Professional consensus now emphasizes risk stratification, individualized assessment, and adherence to updated clinical guidelines.

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🎯 Clinical Recommendations
▪️ Prescribe antibiotic prophylaxis only for patients meeting guideline criteria
▪️ Perform a thorough medical history and cardiac risk assessment
▪️ Avoid routine prophylaxis in healthy individuals
▪️ Educate patients on the importance of oral hygiene and regular dental care
▪️ Stay updated with international guidelines to ensure responsible antibiotic use

✍️ Conclusion
Antibiotic prophylaxis before dental procedures should be limited to well-defined, high-risk patients. While it can be life-saving in specific clinical scenarios, unnecessary use exposes patients and communities to avoidable risks. Evidence-based prescribing, combined with preventive oral healthcare, represents the most effective and ethical approach in contemporary dental practice.

📚 References

✔ Wilson, W., Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison, M., … Durack, D. T. (2007). Prevention of infective endocarditis: Guidelines from the American Heart Association. Circulation, 116(15), 1736–1754. https://doi.org/10.1161/CIRCULATIONAHA.106.183095
✔ Lockhart, P. B., Brennan, M. T., Thornhill, M., Michalowicz, B. S., Noll, J., Bahrani-Mougeot, F. K., & Sasser, H. C. (2009). Poor oral hygiene as a risk factor for infective endocarditis–related bacteremia. Journal of the American Dental Association, 140(10), 1238–1244. https://doi.org/10.14219/jada.archive.2009.0046
✔ Thornhill, M. H., Dayer, M. J., Lockhart, P. B., Prendergast, B., Chambers, J. B., & Shanson, D. (2018). Guidelines on prophylaxis to prevent infective endocarditis. British Dental Journal, 224(5), 293–299. https://doi.org/10.1038/sj.bdj.2018.148

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