COMMENTARY

A Decision-Support Tool for Antibiotic Prophylaxis Before Dental Procedures in Patients With Prosthetic Joints

Joel M. Laudenbach, DMD

Disclosures

April 10, 2017

Antibiotic Prophylaxis for Dental Patients With Prosthetic Joints

Web-based support is now available to dental healthcare providers who are faced with this age-old clinical question: When should we prescribe antibiotic prophylaxis for dental patients with prosthetic joints? A new online tool was adopted by the American Academy of Orthopaedic Surgeons (AAOS) as a result of collaboration with the American Dental Association (ADA) Council on Scientific Affairs (CSA). To appropriately use the new decision-support tool, it is important to first understand the recent clinical practice guideline developments related to the use of prophylactic antibiotics before dental procedures in patients with prosthetic joints.

The 2015 evidence-based clinical practice guideline for dental practitioners is titled, "The Use of Prophylactic Antibiotics Prior to Dental Procedures in Patients With Prosthetic Joints."[1] The guideline states: "In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infections." This panel of experts found no association between dental procedures and prosthetic joint infections. The panel also found no scientifically based efficacy for using antibiotics to prevent prosthetic joint infections.

The clinical practice guideline explains that there may be "special circumstances" in which a clinician may consider antibiotic prophylaxis. And although the clinical practice guideline does not provide a list of these special circumstances, it does recommend that "prophylactic antibiotics should only be considered after consultation with the patient and orthopaedic surgeon" for dental patients with a history of complications associated with joint replacement surgery. Other salient points of the clinical practice guideline include the following[1]:

  • A complete medical history is always recommended when making final decisions regarding the need for antibiotic prophylaxis.

  • The potential harms of antibiotics include risk for anaphylaxis, antibiotic resistance, and opportunistic infections like Clostridium difficile.

  • The benefits of antibiotic prophylaxis may not exceed the harms for most patients.

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