Dental management of infective endocarditis

INTRODUCTION. Infective endocarditis (IE) is an uncommon but potentially devastating disease, with an estimated annual incidence ranging from 2 to 7.9 per 100,000 individuals per year 1,2 and a short-term mortality of 10% to 30%. 3 Through the breakdown of mucocutaneous barriers and induction of bacteremia, dental therapy and other invasive procedures have been linked to seeding of heart. Infective Endocarditis Infective Endocarditis is microbial infection of the heart valves or endocardium and most often is related to congenital or acquired cardiac defects. Endocarditis occurs when bacteria enter the blood stream and infect damaged endocardium or endothelial tissue. Infective endarteritis (IEA) is Microbial infection of endothelium of arteries

Dental Procedures and the Risk of Infective Endocarditis

Brushing, flossing, and visiting your dentist regularly helps keep your smile bright and prevents tooth and gum infections that could lead to endocarditis. Your cardiologist can provide you more information and can answer your questions about preventing endocarditis. Print our patient information sheet What Is Endocarditis INTRODUCTION — The management of infective endocarditis (IE) includes prompt diagnosis, treatment with antimicrobial therapy, and in some cases of complicated IE, surgical management. Preventive measures including antimicrobial prophylaxis may reduce the risk of initial and recurrent IE for patients with relevant risk factors Main complications of left-sided valve infective endocarditis and their management. 9. Other complications of infective endocarditis. 10. Surgical therapy: principles and methods. 11. Outcome after discharge: follow-up and long-term prognosis. 12. Management of specific situations. 13. To do and not to do messages from the guidelines. 14. Appendi Odds ratios of invasive dental treatments and infective endocarditis with control were selected from 6 months before the onset of infective endocarditis in the case-crossover design. For the concordant and discordant pairs, the first and second entries indicate whether a patient received invasive dental treatments in the case or control within an exposure period, respectively

Cardiovascular diseases & Dental Management

Dental Management of Infective Endocarditis - DONTI

Surgery is also sometimes needed to treat endocarditis that's caused by a fungal infection. Depending on your condition, your doctor may recommend repairing your damaged valve or replacing it with an artificial valve made of cow, pig or human heart tissue (biological tissue valve) or man-made materials (prosthetic mechanical valve) Dental management of patients at risk of Infective Endocarditis - Survey. Posted on: April 29, 2019. The Scottish Dental Clinical Effectiveness Programme (SDCEP) published implementation advice regarding Antibiotic Prophylaxis Against Infective Endocarditis in August 2018. To help explore the usefulness and impact of this advice, we are. Introduction. Infective endocarditis (IE) involves damage to the endocardium as a result of microbial colonisation. 1 Local damage to the valves is due to a combination of the host's response and the organism's virulence factor, which enable the stable colonisation of endocardial tissue. These vegetations can propagate systemic symptoms due to the embolisation to other organs

infective endocarditis in at-risk individuals undergoing invasive dental procedures.25 Outcome studies As there is a lack of evidence about the efficacy of antibiotic prophylaxis, expert groups have assessed studies investigating associations between guideline changes and the incidence of infective endocarditis The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between p Prophylaxis against infective endocarditis: Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures; NICE Clinical Guideline (March 2008) Thuny F, Grisoli D, Cautela J, et al; Infective endocarditis: prevention, diagnosis, and management. Can J Cardiol. 2014 Sep30(9):1046-57. doi: 10. Improper dental care. Proper toothbrushing and flossing helps prevent gum disease. If you don't take good care of your teeth and gums, brushing could cause unhealthy gums to bleed, giving bacteria a chance to enter your bloodstream. Vincent LL, et al. Infective endocarditis: Update on epidemiology, outcomes, and management. Current. The guidelines were revised by a multidisciplinary group to reflect recent changes in international recommendations regarding antibiotic prophylaxis for infective endocarditis. The reasons for the changes are explored in this review and the implications for dental practice are discussed

Infective endocarditis and dental procedures: evidence

Dental Health and Endocarditis Preventio

The Scottish Dental Clinical Effectiveness Programme (SDCEP) published implementation advice regarding Antibiotic Prophylaxis Against Infective Endocarditis in August 2018.. To help explore the usefulness and impact of this advice, we are inviting you to take part in a survey which explores dentists' current practice, attitudes and beliefs regarding dental management of patients at risk of. PDF | Infective endocarditis (IF) is found in high-risk groups with congenital or acquired cardiac defects. It is caused by episodes of short... | Find, read and cite all the research you need on.

Dental Management of Medically Compromised Patients Antibiotic prophylaxis is recommended for cardiac patients to prevent infective endocarditis. It is given according to the recommendation of the cardiologist in the situations mentioned, from the latest updates given in tables No 20-22 (page No 125-126) BACKGROUND: Invasive dental treatments (IDTs) can yield temporary bacteremia and have therefore been considered a potential risk factor of infective endocarditis (IE). It is hypothesized that, through the trauma caused by IDTs, bacteria gain entry to the bloodstream and may attach to abnormal heart valves or damaged heart tissue, giving rise to IE

Infective endocarditis is a desease caused by microbial infection of the demaged heart valves or endocardium. Transient bacteremia after dental treatment most often result in infective endocarditis. We report a case of infective endocarditis caused by dental treatment. The patient was a-45-year-old man The most common cause of infective endocarditis following dental, oral, respiratory tract, or oesophageal procedures is Streptococcus viridans (alpha-haemolytic streptococci). Antibiotics for prophylaxis are, therefore, directed toward this organism, and administered as a single dose 30 to 60 minutes before the procedure The Prevention of Infective Endocarditis Guidelines released by the American Heart Association in 2007 www.aetnadental.com 23.05.806.1 A (2/16) Earn 1 continuing education credit This continuing education course was prepared by faculty at the Columbia University College of Dental Medicine and the College of Physicians and Surgeons

Dental procedures, antibiotic prophylaxis, and

Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. Complications may include backward blood flow in the heart, the heart struggling to pump a sufficient amount of blood to meet the body's needs (heart failure), abnormal. Background: Infective endocarditis (IE) is a microbial (usually bacteria) infection affecting the heart tissue or the adjacent vascular endothelium. The blood-circulating microbes usually need to be available in a certain inoculum to allow invasion and thus infect the heart. Moreover, if the valve annulus is affected, the infection will spread int

Infective endocarditis 1. Infective EndocarditisPRATIK KUMAR080201186 2. DefinitionInfection of the endocardial surface of heart characterized by - Colonization or invasion of the heart valves (native orprosthetic) or the mural endocardium by a microbe, - leading to formation of bulky, friable vegetation composedof thrombotic debris and organisms - often associated with destruction of. Infective endocarditis IE is an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect. Its intracardiac effects include severe valvular insufficiency, which may lead to intractable congestive heart failure, myocardial abscesses & death Infective Endocarditis And Dental Procedures Evidence Pathogenesis And Prevention. Infective endocarditis and dental procedures : evidence pathogenesis prevention do patients at risk of need antibiotics before procedures? the bmj springerlink lance What is infective endocarditis? • Endocarditis is a rare infection of the inside of the heart or the main arteries. • It most commonly affects one or more of the heart valves but may also occur around holes between the heart chambers, at the site of abnormalities in the walls of arteries or at the site of previous heart or arterial surgery

Dental Management 2 Infective Endocarditis Flashcards

· Dental evaluation for pre-valve surgical patients, and upon discharge of all confirmed IE cases. Positive . Echo? Reference: Infective Endocarditis - Adult -Inpatient Clinical Practice Guideline. Inpatient Management of Adult Patients with Suspected Infective Endocarditis Algorithm . YES. NO. Additional Details A. In the absence of sepsis o Habib G, et. al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009) The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC) Infective endocarditis constitutes a group of clinical situations, whose cause and location can vary. The Task Force on the Prevention, Diagnosis and Treatment of Infective Endocarditis of the European Society of Cardiology (Habib et al., 2009) proposed a classification of infective endocarditis into different categories relating to:site of infection: left side; right sid Aortic stenosis and mitral valve insufficiency are common precipitating causes of infectious endocarditis in older persons. These degenerative cardia

Dental procedures are thought to be a major source of bacteremia requiring antimicrobial prophylaxis for patients at risk of developing infective endocarditis but, in fact, bacteremia frequently occurs with routine daily activities, 94 and the cumulative effect of random bacteremia may be significantly greater than that from the occasional. Advances in medical and antibiotic management of infective endocarditis. Cardiol Clin. 1996;14:405-36. 9. Geraci JE, Wilson WR. Symposium on infective endocarditis. III. Endocarditis due to gram. Introduction. Native mitral valve infective endocarditis (IE) represents a small but important subset within IE. IE is often classified into left (mitral and aortic) and right (tricuspid and pulmonic) sided etiologies as well as by the nature of the valve affected (native or prosthetic) [].IE holds an incidence of three-nine cases per 100,000 persons, with 40% of these cases affecting the.

Infective Endocarditis American Heart Associatio

  1. imum follow-up of 3-months. Conclusion: Staphylococcus aureus is virulent and highly pathogenic, driving severe sepsis and advanced tissue destruction in SAE.
  2. 1. Preface to Revision. In March 2018, the revised version of the guidelines regarding infective endocarditis (IE) was published in Japanese from the Japanese Society of Cardiology (the Guidelines for Prevention and Treatment of Infective Endocarditis (JCS2017)). 1, 2 On the revision of the guidelines we reorganized the Guideline Writing Group.In addition to the Japanese Circulation Society.
  3. Infective endocarditis is a rare but life-threatening infection of the endocardium that affects the heart valves and neighboring structures. While the oral cavity harbors more than 700 strains of bacteria, only a small number are associated with infective endocarditis

Bacteremia is a prerequisite for the development of infective endocarditis [], and it is a more common phenomenon than might be assumed.In fact, transient bacteremia often occurs in various dental and surgical procedures, as well as in toothbrushing, flossing, and even chewing [].Despite the ubiquity of transient bacteremia, infective endocarditis is a rare condition with annual incidence in. To educate clinicians on endocarditis and its prevention, the myths of dental-induced endocarditis prevention are analyzed. Myth 1: For the most part, physicians and dentists are aware of and comply with American Heart Association guidelines on antibiotic prophylaxis for prevention of infective endocarditis

PPT - Infective Endocarditis PowerPoint Presentation, free

Overview of management of infective endocarditis in adults

Infective endocarditis is a substantial cause of morbidity and mortality in children and adolescents despite new advantages in management and prophylaxis. Infective endocarditis can include acute and subacute bacterial endocarditis, as well as nonbacterial endocarditis caused by viruses, fungi, and other microbiologic agents Infective endocarditis is an infection in the heart valves or endocardium. It can lead to stroke and heart failure. Learn about the symptoms and treatments intended as a companion to the 2007 Prevention of Infective Endocarditis - Recommendations by the American Heart Association published in the June issue of JADA by the American Heart Association. When referring to the 2007 Recommendations, readers also should consult this legal statement

The recent publication of new Australian guidelines 1 for antibiotic prophylaxis for the prevention of infective endocarditis (IE) represents a major revision of previously accepted protocols. The changes follow similar revisions in the United States of America 2 and the United Kingdom. 3 They have occurred largely as a result of critical analysis of the evidence, which has questioned the. The incidence of infective endocarditis is between 3 and 10 episodes per 100,000 person-years with a peak incidence during the ages of 70-80 of 14.5 episodes per 100,000 person-years [2-5].Risk factors for IE include advanced age, poor dentition, injection drug use, structural heart disease (specifically valvular and congenital heart disease), the presence of prosthetic heart valves, and. Quantifying infective endocarditis risk in patients with predisposing cardiac conditions. Eur Heart J. 2018;39:586-95. Lewis T, Grant R. Observations relating to subacute infective endocarditis. Heart. 1923;10:21-77. Okell CC, Elliott SD. Bacteraemia and oral sepsis: with special reference to the aetiology of subacute endocarditis. Lancet. 1935. Guideline on the Prevention of Infective Endocarditis Associated with Dental and other Medical Interventions. New Zealand NHF Sept 2008. Ferrieri P, Gewitz M, Gerber M, Newburger J, Dajani A, Shulman S et al. Unique features of infective endocarditis in childhood. Pediatrics 109 (5): 2002 Infective endocarditis (IE) is associated with significant morbidity and mortality. Prevention is therefore an important clinical entity. The maintenance of optimal oral health is likely to play the most important role in protecting those at risk for IE. Both patients and health care practitioners must be educated in this regard

2015 ESC Guidelines for the management of infective

  1. Infective endocarditis is a serious condition characterised by colonisation or invasion of the heart valves or the mural endocardium by a microbiological agent. Vegetations form containing fibrin, platelets and micro-organisms which seed into the circulation causing persistent fever, non-specific systemic symptoms, murmurs and emboli
  2. Streptococcus mutans, a major pathogen of dental caries, is regarded as a causative agent of infective endocarditis (IE), which mainly occurs in patients with underlying heart disease. However, it remains unknown whether severe dental caries that extend to pulp space represent a possible route of infection. In the present study, we evaluated the virulence of S. mutans for IE development using.
  3. Infective endocarditis (IE) is an uncommon but life-threatening infection. Despite advances in diagnosis, antimicrobial therapy, surgical techniques, and management of complications, patients with IE still have high morbidity and mortality rates related to this condition
  4. Infective endocarditis is a life-threatening infection inside the lining of the heart (called the endocardium) or in the heart valves, the flaps that keep blood flowing in and out of the heart. The infection is caused by bacteria or fungus that enters the heart
  5. Objective Despite improvements in its management, infective endocarditis (IE) is associated with poor survival. The aim of this study was to evaluate the impact of a multidisciplinary endocarditis team (ET), including a cardiologist, microbiologist and a cardiac surgeon, on the outcome of patients with acute IE according to medical o
  6. dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis

In this lecture I explain in step-by-step fashion the basics of Dental Management of Infective Endocarditis. a photo guide is attached to the guide to aid in Dental management of patients with infective endocarditis is a notable concern. The guidelines did not discuss prophylactic antibiotic use for dental procedures in patients at high risk for. Compared with non-exposure periods, no statistically significant increased rate of oral streptococcal infective endocarditis was observed during the three months after an invasive dental procedure. How to identify patients at a high risk of developing Infective Endocarditis and how to prevent it by proper prophylaxis

Risk of Infective Endocarditis After Invasive Dental

  1. Up to date causal relationship has been demonstrated between dental manipulations and the onset of infective endocarditis (IE). However, since 1955, numerous expert committees have proposed antibiotic prophylaxis (AP) to prevent bacteraemia of oral origin. Controversy regarding the efficacy of AP prior to the dental procedures has intensified in recent years because of the lack of conclusive.
  2. Infective Endocarditis (IE) is an infectious disease of the heart and surrounding vessels. It is most commonly seen in patients with a history of congenital or acquired cardiac disease, however an increasing number of cases are due to invasive instrumentation procedures and indwelling prosthetic material (1).. IV drug users have an increased incidence of IE however fortunately this is still.
  3. Prevention of infective endocarditis associated with dental treatment and other medical interventions August 2000 The New Zealand medical journal 113(1113):289-9
  4. Committees recognize the importance of good oral and dental health and regular visits to the dentist for patients at risk of IE. These guidelines do not change the fact that your cardiac condition puts you at increased risk for developing endocarditis. If you develop signs or symptoms of endocarditis—such as unexplained fever—see your docto
Infective endocarditisAtrial septal defect

ESC Guidelines on Infective Endocarditis (Prevention

  1. National guidance on the management of Staphylococcus aureus bacteraemia in adults (SAB) is available. Murmur and fever - suspect endocarditis. 'Normal' echo [transthoracic (TTE) or transoesophageal (TOE)] does not exclude endocarditis. TOE may help if TTE is 'normal' or if images are poor (e.g. lung disease, obesity)
  2. T/F: Dental procedures are a direct cause of infective endocarditis FALSE--Prophylactic antibiotic therapy may prevent an exceedingly small number of cases of IE, and the risk of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy
  3. Infective endocarditis. Infective endocarditis (IE) is relatively rare in the UK. However, delays in diagnosis and treatment can lead to serious complications, and be fatal. Thus, it is important to be aware of the condition and its management
  5. Abusallama

Summary of Infective Endocarditis (IE) Prevention Guidelines from the American Heart Association* Endocarditis is more likely a result of daily exposure to bacteria, rather than exposure during a dental, gastrointestinal tract or genitourinary tract procedure Preventing infective endocarditis. Good oral and dental hygiene is thought to be important in preventing infective endocarditis. In particular, if you have any condition which increases your risk of developing infective endocarditis, then, don't let any dental problems such as a dental abscess or gum disease go untreated Do invasive dental procedures cause infective endocarditis? Invasive dental procedures cause bacteraemia, which is a necessary precursor to infective endocarditis,13 but it is unclear if dental interventions cause infective endocarditis. In a prospective Dutch cohort of 427 cases of infective endocarditis, only 31 (11%) had undergone an invasive procedure (medical or dental) within the. This guideline covers preventing infective endocarditis (IE) in children, young people and adults. It focuses on people at increased risk of infective endocarditis undergoing dental, gastrointestinal... Read Summar This statement updates and revises recommendations for the diagnosis and management of infective endocarditis (IE) published by the American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease in 1995. In addition, it updates and incorporates recommendations for the management of complications in IE published by.

Infective Endocarditis Treatment & Management: Approach

A 64-year-old man presents to the emergency department with chest pain, fever, fatigue, and arthralgias. His past medical history is significant for rheumatic heart disease and a dental procedure a few weeks before admission. He currently shows no stigmata of endocarditis on physical examination, although endocarditis is suspected A third study found a significant increase in streptococcal infective endocarditis, but it did not report the incidence of viridans streptococcal infective endocarditis, nor provide any data on dental treatment or antibiotic prophylaxis. 29 No firm conclusions can therefore be drawn about the impact of the change in the guidelines

Antibiotic Prophylaxis Against Infective Endocarditis - SDCE

Endocarditis Prophylaxis Recommendations These recommendations are taken from 2017 American Heart Association and American College of Cardiology focused update of the 2014 AHA/ADA Guideline for Management of Patients with Valvular Disease (1) and cited by the ADA (2). Prophylaxis against infective endocarditis is reasonable before dental Because the occurrence of infective endocarditis (IE) continues to be associated with high mortality, a working group was created by the Dutch Society of Cardiology to examine how the most recent European Society of Cardiology (ESC) guidelines for IE management could be implemented most effectively in the Netherlands. In order to investigate current Dutch IE practices, the working group. Infective endocarditis is a rare disease, with an incidence of two to six episodes per 100,000 habitants/year. Incidence is higher in elderly people; besides, this group is often affected by many comorbidities. There is a clear and observable change in the spectrum of heart diseases predisposing to infective endocarditis in the last decades. Up to one-third of the patients acquire the disease. Prevention of infective endocarditis - Guideline. Download our guideline for prevention of infective endocarditis associated with dental and other medical interventions (2008)

New guidelines for prevention of infective endocarditis were released by the American Heart Association April 19. The AHA and ADA now recommend that fewer dental patients with heart disease receive antibiotic prophylaxis before dental procedures to prevent the heart infection called infective endocarditis (IE). The guidelines . . Infective endocarditis: An intensive care perspective. Trends Anaes Crit Care 2010;2 (1) 36-41 [ Free Full Text ] Sonneville R, Mourvillier B, Bouadma L, Wolff M. Management of neurological complications of infective endocarditis in ICU patients The hallmark of endocarditis is a fever and a new murmur. Signs and symptoms of heart failure may be present. Acute Care Management. Nursing Diagnosis: Decreased cardiac output secondary to valvular dysfunction from infective process. Outcome Criteria. Patient alert and oriented; Skin warm and dry; Pulses strong and equal bilaterally; O2 sat ? 95 Infective endocarditis (IE) is an infection of the endocardium (particularly the valve leaflets) with a yearly incidence of 3-10 per 100,000 [1,2,3] and is characterised by the development of infected heart valve vegetations.Prognosis is poor with an in-hospital mortality of 15-20%, rising to approximately 30% at 1 year [1,2,3].Prolonged high-dose intravenous antibiotics are the mainstay of.

• Dental treatment not a risk factor in population - based, case-control study (Strom et al., AIM '98) - Prosthetic valves, antecedent endocarditis major risk factors Prevention of Infective Endocarditis •Hgih rski - Prosthetic valve - Complex congenital heart disease - Previous endocarditis - Cardiac transplantation with valvulopath Infective endocarditis is an infection of the endocardial surface of the heart and usually involves one or more heart valves but may occur on septal defects or the heart wall. Its incidence is appr.. Infective Endocarditis (IE) Prophylaxis . Indications (AHA 2007) Prosthetic valve. Previous IE. Congenital heart disease, specifically: Unrepaired cyanotic heart disease, including palliative shunts & conduits. Congenital heart disease repaired within the last 6 months. Repaired but residual defects next to prosthetic materia On April 19, 2007 the American Heart Association (AHA) published its updated recommendations for the prevention of infective endocarditis in heart patients scheduled to undergo dental procedures. The new guideline will significantly affect oral and maxillofacial surgery practice patterns and simplify the management of many patients

Dental management of endocarditis in childre

Preparing for dental work If you are in one of the groups that are at risk of developing infective endocarditis, you need to prepare for dental work. Ask your doctor if any you need to take any special precautions. You may be given a prescription for antibiotics. Discuss your condition with your dentist before treatment starts Management of infective endocarditis: challenges and perspectives Franck Thuny, Dominique Grisoli, Frederic Collart, Gilbert Habib, Didier Raoult Despite improvements in medical and surgical therapies, infective endocarditis is associated with poor prognosis and remains a therapeutic challenge Endocarditis is a noncontagious chronic infection of the valves or lining of the heart, mainly caused by bacteria, although fungi can also be associated with this infection ().The risk of infection of heart valves in persons predisposed to acquiring infective endocarditis increases with the following conditions: congenital heart disease, rheumatic fever, major dental treatment, open heart.

PDF: Antibiotic Prophylaxis 2017 Update - AAE Quick

Antibiotic Prophylaxis Prior to Dental Procedure

M. Zoumpoulakis1 / F. Anagnostou2 / S. Dalampiras3 / L. Zouloumis3 / C. Pliakos4 1Postgraduate Program of Hospital Dentistry Dental School of Aristotle University of Thessaloniki, Greece 2National School of Public Health 3Department of OMFS Dental School of Aristotle University of Thessaloniki 4Department of Cardiology AXEPA Hospital Thessaloniki, Greece Summary Infective endocarditis (IE), an. Some dental and surgical procedures increase the risk of endocarditis because bacteria may be introduced into the bloodstream. Endocarditis is also known as infective endocarditis or bacterial endocarditis. Symptoms of endocarditis The symptoms of acute bacterial endocarditis (ABE) occur within a few weeks of infection

Infective endocarditis You may have recently been diagnosed or treated for a heart condition called infective endocarditis, or you may be wondering if you are at risk of this condition. This leaflet explains what the causes and symptoms of infective endocarditis are, and tells you what actions to take if you experience them The new recommendations address prevention, diagnosis, and treatment of infective endocarditis. The guidance with respect to antibiotic prophylaxis is similar to US advice, experts say Endocarditis is an inflammation of the lining of the heart valves that is most often caused by infection. Most people who develop this condition already have heart problems and are over 50 years old, but it can occur at any age, including in children. While not very common, this can be a very serious disease. Men are twice as likely to be affected as women The diagnosis of infective endocarditis should be considered in anyone with sepsis of unknown origin, or fever in the presence of risk factors (previous infective endocarditis, a prosthetic valve or cardiac device, valvular or congenital heart disease, intravenous drug use, indwelling intravenous lines, immunosuppression, or a recent dental or.

CLINIC POLICY AND PROCEDURES MANUALgraphicCongenital heart disease | Health Navigator NZPPT - Management Of Medical Emergencies In The Dental
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