Patients with prosthetic joints should not use preventative antibiotics before dental treatments

January 21, 2015

Generally, patients with prosthetic joint implants should not use prophylactic antibiotics prior to dental procedures to prevent prosthetic joint infection (PJI), according to an updated American Dental Association clinical practice guideline.

Generally, patients with prosthetic joint implants should not use prophylactic antibiotics prior to dental procedures to prevent prosthetic joint infection (PJI), according to an updated American Dental Association clinical practice guideline.

A panel of experts tasked by the ADA Council on Scientific Affairs determined the recommendation, which was published in the January issue of The Journal of the American Dental Association (JADA).

“The panel found that the current best evidence failed to demonstrate an association between dental procedures and prosthetic joint infection,” said Dr. Thomas Hart, chair of the ADA Council on Scientific Affairs. “However, this guideline should be integrated with professional judgment and used along with other available, patient-specific data, needs and preferences to determine an evidence-based approach to care.”

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The panel based the new guideline on updated literature search results and direct evidence from the 2012 panel. It identified four case-control studies.

Panel members determined current best evidence failed to demonstrate a connection between dental procedures and prosthetic joint infection. They also presented information concerning antibiotic resistance, adverse drug reactions and costs associated with prescribing antibiotics for PJI prophylaxis.

The panel recommends both practitioner and patient should consider possible the risks in providing dental care without antibiotic prophylaxis, as well as the risks of frequent antibiotic use.

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Dentists should note there does not appear to be a conflict between the updated ADA prosthetic joint infection practice guideline and a recent Lancet publication on infective endocarditis.

"Prosthetic joint infection and infective endocarditis are different disorders," said Dr. Thomas Sollecito, who is one of nine members of the panel. "They have different risk factors. The microorganisms involved in PJIs are often from different ecosystems than the oral cavity whereas those in infective endocarditis can be from the mouth."

The 2012 guidelines, “Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Evidence-based Guideline and Evidence Report,” were co-developed by a 2012 panel of American Academy of Orthopaedic Surgeons and ADA authors.

The 2014 recommendation, "The Use of Prophylactic Antibiotics Prior to Dental Procedures in Patients with Prosthetic Joints: Evidence-Based Clinical Practice Guideline for Dental Practitioners," can be accessed in the January 2015 print edition of JADA and the JADA website

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