No Antibiotics for Ortho-Dental Patients?

It’s not a ‘say ah’ moment, but an ‘aha’ moment…The American Academy of Orthopaedic Surgeons (AAOS), and the American Dental Association (ADA) have found that there is insufficient evidence to recommend the routine use of antibiotics for patients with orthopedic implants to prevent infections prior to having dental procedures because there is no direct evidence that routine dental procedures cause prosthetic joint infections.

The AAOS and ADA’s recommendations are based on a collaborative evidence-based clinical practice guideline that focuses on the possible linkage between orthopedic implant infection and patients undergoing dental procedures.

“As clinicians, we want what is in the best interest of our patients, so this clinical practice guideline is not meant to be a stand-alone document. Instead it should be used as an educational tool to guide clinicians through treatment decisions with their patients in an effort to improve quality and effectiveness of care, ” said David Jevsevar, M.D., MBA, in the December 18, 2012 news release. Dr. Jevsevar is chair of the AAOS Evidence-Based Practice Committee which oversees the development of clinical practice guidelines.

“It has been long debated that patients with orthopaedic implants, primarily hip and knee replacements, are prone to implant infections from routine dental procedures, ” added Dr. Jevsevar who also is an orthopedic surgeon in St. George, Utah. “What we found in this analysis is that there is no conclusive evidence that demonstrates a need to routinely administer antibiotics to patients with an orthopaedic implant, who undergo dental procedures.”

Elliot Abt, D.D.S., MS, MSc, who served as member of the AAOS-ADA work group on behalf of the ADA, pointed out that the review committee conducted a thorough review of existing clinical research published in the peer-reviewed literature.

“This guideline was based primarily on clinical research which examined a large group of patients, all having a prosthetic hip or knee and half with an infected prosthetic joint, ” said Dr. Abt, a general dentist in Skokie, Ill., and a member of the ADA Council on Scientific Affairs. “The research showed that invasive dental procedures, with or without antibiotics, did not increase the odds of developing a prosthetic joint infection.”

This clinical practice guideline, with three recommendations, is based on a systematic review of the correlation between dental procedures and prosthetic joint infection (PJI).

• Recommendation one, which is based on limited evidence, supports that practitioners consider changing their longstanding practice of prescribing prophylactic antibiotics for patients who undergo dental procedures. Limited evidence shows that dental procedures are unrelated to PJI.
• Recommendation two addresses the use of oral topical antimicrobials (topical antibiotic administered by a dentist) in the prevention of PJI in patients undergoing dental procedures.  There is no direct evidence that the use of oral topical antimicrobials before dental procedures will prevent PJI.
• Recommendation three is the only consensus recommendation in the guideline, and it supports the maintenance of good oral hygiene.