The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints

Evidence-based clinical practice guideline for dental practitioners—a report of the American Dental Association Council on Scientific Affairs

Thomas P. Sollecito, DMD, FDS RCSEd; Elliot Abt, DDS, MS, MSc; Peter B. Lockhart, DDS, FDS RCSEd, FDS RCPS; Edmond Truelove, DDS, MSD; Thomas M. Paumier, DDS; Sharon L. Tracy, PhD; Malavika Tampi, MPH; Eugenio D. Beltrán-Aguilar, DMD, MPH, MS, DrPH; Julie Frantsve-Hawley, PhD

In 2012, a panel of experts representing the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) (the 2012 Panel) published a systematic review and accompanying clinical practice guideline (CPG) entitled “Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Evidence-based Guideline and Evidence Report.”1-3 The 2012 Panel initially considered 222 questions concerning the relationship between dental procedures, bacteremia (as an intermediate outcome), and the risk of developing a prosthetic joint infection (PJI) as a clinical end point. The 2012 Panel published a comprehensive evidence-based guideline. The release of this guideline was followed by calls to the ADA Member Service Center hotline requesting additional clarification, which indicated that this guideline was 1 of the top 2 issues of concern to dental practitioners. Therefore, the ADA’s Council on Scientific Affairs convened a panel of experts (the 2014 Panel) to provide dental professionals with a more specific and practical set of guidelines, the results of which are included in this article.

The 2014 Panel considered the direct evidence linking a PJI with a dental procedure but did not reevaluate intermediate outcomes, including bacteremia4 from manipulation of oral mucosa. The full report of the 2012 Panel, which includes intermediate outcomes, is available online.1 The 2014 Panel addressed the following clinical question: For patients with prosthetic joints, is there an association between dental procedures and PJI, and, therefore, should systemic antibiotics be prescribed before patients with prosthetic joint implants undergo dental procedures? In this article, we present the evidence to answer this question and provide clinical recommendations.

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This article has an accompanying online continuing education activity available at: http://jada.ada.org/ce/home. Copyright 2015 American Dental Association. All rights reserved.

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