Antibiotic Prophylaxis for Patients with Prosthetic Joints
(Originally published in September 2003)

Question: Has there been an update to the recommendations for antibiotic prophylaxis for dental patients with prosthetic joints?

Answer: In 1997, an expert consultant panel consisting of dentists, orthopaedic surgeons and infectious disease specialists led by the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) convened to publish their first Advisory Statement on Antibiotic Prophylaxis for Dental Patients with Prosthetic Joints. In 2003, the panel reconvened and published the first periodic update of the 1997 statement. In addition, they created a new patient handout for dentists to share with their patients. The 2003 statement includes some modifications of the classification of patients at potential risk and of the incidence stratification of bacteremic dental procedures, but no changes in terms of suggested antibiotics and antibiotic regimens.¹ Antibiotic prophylaxis is not indicated for dental patients with pins, plates, or screws, nor is it routinely indicated for most dental patients with total joint replacements.^1,2,3,4 It is advisable to consider premedication in a small number of patients who may be at potential increased risk of experiencing hematogenous total joint infection.

The 2003 Advisory Statement encourages dentists to consult with the patient's physician if the physician recommends a regimen that is not consistent with the current guidelines. The perceived potential benefits of antibiotic prophylaxis must be weighed against the known risks of antibiotic toxicity; allergy; and development, selection and transmission of microbial resistance. After consulting with the physician, the dentist may decide to follow the physician's recommendation or, if in the dentist's professional judgement antibiotic prophylaxis is not indicated, may decide to proceed without antibiotic prophylaxis. However, the Advisory Statement reminds practitioners that the dentist is ultimately responsible for making treatment recommendations for his or her patients based on the dentist's professional judgement.

The updated statement and recommendations of the ADA, AAOS, and the expert panel can be found in the July 2003 issue of the Journal of the American Dental Association.¹

References
1. American Dental Association; American Academy of Orthopaedic Surgeons. Advisory Statement: Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 2003;134:895-899.
2. Council on Dental Therapeutics. Management of dental patients with prosthetic joints. J Am Dent Assoc 1990;121:537-538.
3. Eskinazi D, Rathburn W. Is systemic antimicrobial prophlyaxis justified in dental patients with prosthetic joints? Oral Surg Oral Med Oral Pathol 1988;66:430-431.
4. Cawson RA. Antibiotic prophylaxis for dental treatment: for hearts but not for prosthetic joints. Br Dent J 1992;304:933-934.

(Lt Col Harte)