ADA Guidelines Update for the INBDE (Trauma + Prophylaxis)

With new information always being gathered, guidelines on how to treat patients can change over time. Bootcamp.com is working behind the scenes to provide you with the most updated information to help you prepare for your exam!

Two major updates have occurred recently that affect dental practice: how to handle avulsed teeth, and antibiotics for use in prophylaxis. As of January 2023, the ADA has updated the INBDE to the current guidelines.

Update #1: Milk is the preferred storage medium for avulsed teeth.

In 2020, the International Association of Dental Traumatology (IADT) released updated guidelines for the evaluation and management of traumatic dental injuries. 

Previously, Hank’s balanced salt solution (HBSS) was the recommended storage medium for avulsed teeth. However, in 2020, the guidance was updated to specify that in “descending order of preference, milk, HBSS, saliva (after spitting into a glass for instance), or saline are suitable and convenient storage mediums”.

(https://onlinelibrary.wiley.com/doi/full/10.1111/edt.12573)

Update #2: Clindamycin is no longer recommended for antibiotic prophylaxis.

In 2021, the American Heart Association (AHA) released a new scientific statement no longer recommending the use of clindamycin for antibiotic prophylaxis due to its high risk of Clostridium difficile infection, and the high morbidity and mortality associated with it. Azithromycin or clarithromycin are preferred alternatives.

(https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000969)

‍New guidelines (in effect for current INBDE, and the correct answer):

• Milk is the best storage medium for avulsed teeth.
• Clindamycin is no longer recommended for antibiotic prophylaxis.