The College of Dentistry’s policy regarding antibiotic prophylaxis for patients with prosthetic joints acknowledges the evidence-based clinical practice guideline (CPG) published in the Journal of the American Dental Association in January, 2015.1 This CPG is intended to clarify the joint guideline published in December, 2012 by the American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA).2 The policy will be reviewed annually or on an as-needed basis to reflect changes in evidence levels for the practice of antibiotic prophylaxis for patients with prosthetic joints.
Recommendation 1: There is no need for dental practitioners to routinely administer prophylactic antibiotics prior to dental procedures to prevent infection in patients with orthopedic implants. This recommendation is based on the most current evidence-based science.
Recommendation 2: Dental practitioners should consider premedication under the following circumstances where the patients may be at increased risk for joint infection:
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Previous prosthetic joint infections
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Immunocompromised/immunosuppressed patients:
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inflammatory arthropathies such as rheumatoid arthritis, systemic lupus erythematosus, etc.
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Chemotherapy or radiation-induced immunosuppression secondary to malignancies
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AIDS
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Type I or poorly controlled Type II diabetes
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Hemophilia
For patients referred to in Recommendation 2, the patient’s physician (preferably an orthopedic surgeon) should provide input regarding patient management. If the physician desires the patient to receive prophylactic antibiotics the physician should provide the patient with a prescription for the antibiotic of the physician’s choice.
The dental practitioner should not write the prescription.
References:
1 Sollecito T, Abt E, Lockhart P, et al. "The Use of Prophylactic Antibiotics Prior to Dental Procedures in Patients with Prosthetic Joints". JADA 2015;146(1):11-16.
2 American Academy of Orthopaedic Surgeons; American Dental Association. "Prevention of Orthopedic Implant Infection in Patients Undergoing Dental Procedures: Evidence-based Guideline and Evidence Report". Rosemont, IL: American Academy of Orthopedic Surgeons;2012.
