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Guideline: Antibiotics Need Not Be Routine For Dental Work

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The available evidence is insufficient to recommend routine antibiotics for dental procedures in persons with joint replacement, according to a new clinical practice guideline from the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA). This guideline, titled “Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures,” replaces the previous AAOS Information Statement, “Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacement.”

A collaborative systematic review of the correlation between dental procedures and prosthetic joint infection (PJI) found no direct evidence of a causal link.

“It has been long debated that patients with orthopaedic implants, primarily hip and knee replacements, are prone to implant infections from routine dental procedures,” David Jevsevar, MD, MBA, chair of the AAOS Evidence Based Practice Committee, said in a news release. “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.”

In the United States, patients underwent a total of more than 302,000 hip replacements and 658,000 knee replacements in 2010. Mean infection rate is 2%, according to findings from hip and knee replacement studies reviewed by the guideline authors. Infectious organisms may enter the surgical wound during or after the joint replacement procedure, and complications may include surgical drainage or debridement and long courses of antibiotics.

“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,” AAOS-ADA work group member Elliot Abt, DDS, a general dentist in Skokie, Illinois, and a member of the ADA Council on Scientific Affairs, said in the release. “The research showed that invasive dental procedures, with or without antibiotics, did not increase the odds of developing a prosthetic joint infection.”

The clinical practice guideline includes 3 specific recommendations:

1. Practitioners should consider changing their customary practice of prescribing prophylactic antibiotics to patients undergoing dental procedures. This recommendation is based on limited evidence that dental procedures are unrelated to PJI. 2. There is no direct evidence that the use of oral topical antimicrobials (ie, topical antibiotic administered by the dentist) before dental procedures will prevent PJI. This is an inconclusive recommendation, in that the guidelines authors were unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopedic implants. 3. Good oral hygiene should be maintained. This is the only consensus recommendation in the guideline. Continue reading this article HERE.