Antibiotic prophylaxis for patients with joint prostheses — still a dilemma for dental practitioners

Seymour, R. A.; Whitworth, John; Martin, Michael V.

doi:10.1038/sj.bdj.4810352

Cited by 31 publications

(31 citation statements)

References 24 publications

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“…This was despite the dentists having been given relevant literature to the contrary to read, supplemental to the educational component of the study. [19][20][21][22][23][24][25][26][27][28][29] As a consequence, it is suggested that should this study be replicated elsewhere, a third cycle in the audit spiral could be considered, so that after the second meeting of the dentists, where the improved results would be discussed and education reinforced, there would then be another opportunity for anonymous scrutiny and peer review to achieve even further improvement.…”

Section: Discussionmentioning

confidence: 99%

The impact of clinical audit on antibiotic prescribing in general dental practice

Chate¹,

White

Hale

et al. 2006

Br Dent J

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• Describes an audit undertaken in the East of England on antibiotic prescribing in general dental practice.• The protocols of an original North West of England audit published in 2001 were deliberately replicated, in order to be able to pool the data and obtain a sample size of at least 1% of all UK dentists.• The combined Regional results confi rm that clinical audit reduces both the number of errors made by dental practitioners when writing out a prescription, as well as the number of those which are issued inappropriately, as compared to contemporary prescribing guidelines. I N B R I E FThe impact of clinical audit on antibiotic prescribing in general dental practice Objective To reduce the number of antibiotics inappropriately prescribed by general dental practitioners, and to increase overall prescription accuracy. Design A prospective clinical audit carried out between September and March of 2002-3 and 2003-4. Setting General dental practices in Eastern England. Subjects and methods The pre-audit antibiotic prescribing practices of 212 general dental practitioners were recorded over an initial six week period. On each occasion this included which antibiotic had been chosen, together with its dose, frequency and duration, as well as the clinical condition and reason for which the prescription had been raised. When related to prophylaxis, the patient's medical history was also noted. Following education on contemporary prescribing guidelines, presentations which illustrated the practitioners' previous errors, and the agreement of standards to be achieved, the process was repeated for another six weeks, and the results compared. Results In the pre-audit period, 2,951 antibiotic prescriptions were issued, and during the audit this was reduced by 43.6% to 1,665. The majority were for therapeutic reasons, with only 10.5% and 13.6% for medical prophylaxis during the pre-audit and audit periods respectively. Over both periods, amoxicillin and metronidazole were the two most commonly prescribed antimicrobials (63.4% and 21.2% respectively). In the pre-audit period, only 43% of all prescriptions were error free in dose, frequency, and/or duration of use, but this rose signifi cantly to 78% during the audit. Equally, using contemporary published guidelines, out of all the prescriptions made in the pre-audit period, only 29.2% were deemed to be justifi ed, as compared to 48.5% during the audit. Conclusions Clinical audit, in conjunction with education, and prescribing guidelines can favourably change antibiotic prescribing patterns among general dental practitioners.

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Section: Discussionmentioning

confidence: 99%

The impact of clinical audit on antibiotic prescribing in general dental practice

Chate¹,

White

Hale

et al. 2006

Br Dent J

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“…To accomplish this goal we need even better communication and collaboration between medical and dental colleagues, so that the practitioner can render the best treatment on the basis of the best available evidence and appropriate consultation(s). (38) Case report 5 Rubin et al (16) Case report 5 Ainscow and Denham (21) Prospective 4 Moderazo et al (39) Retrospective study 4 Jacobson et al (18) Retrospective study 4 Ching et al (20) Review 4 Waldman et al (14) Retrospective study 4 LaPorte et al (17) Retrospective study 4 Jaconbsen and Murray (19) Retrospective study 4 Uçkay et al (12) Systematic review 3 Seymour et al (40) Retrospective study 4…”

Section: Discussionmentioning

confidence: 97%

Premedication of Patients Undergoing Dental Procedures Causing Bacteremia after Total Joint Arthroplasty

Aminoshariae

Kulild

2010

Journal of Endodontics

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“…Laporte et al reviewed 2973 cases of joint replacements and found that 52 had late infections. 2 They were of the opinion that three of these were 'strongly associated' with a dental procedure. Two of these three patients had additional risk factors, namely, diabetes and rheumatoid arthritis.…”

Section: Can Orthopaedic Implants Become Infected By Bloodborne Bactementioning

confidence: 99%

“…The traditional orthopaedic answer and, to a lesser extent, dental answer to this question is in the affirmative. 1,2 The basis to this tradition is partly anecdotal, partly historical and partly legal. Anecdotally there have been isolated cases of joint infection related to dental disease or treatment.…”

Section: Introductionmentioning

confidence: 99%

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Patients with artificial joints: do they need antibiotic cover for dental treatment?

Scott

Morgan

Avent

et al. 2005

Australian Dental Journal

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This study reviews whether patients with artificial joints need antibiotic cover for dental treatment. Generally in Australia the practice has developed of giving most patients with artificial joints antibiotic prophylaxis for a wide range of dental procedures. This is partly on anecdotal grounds, partly historical and partly for legal concerns. It has been encouraged by some guidelines. Scientifically, the risk and the benefit of each step in the process needs to be analysed. This review shows that the risk of an artificial joint becoming infected from a bacteraemia of oral origin is exceedingly low whereas the risk of an adverse reaction to the antibiotic prophylaxis is higher than the risk of infection. If all patients with artificial joints receive antibiotic prophylaxis then more will die from anaphylaxis than develop infections. Factors which balance the risk benefit are if the patient is seriously immunocompromised, if the joint prosthesis is failing or chronically inflamed and if the dental procedures, such as from extractions and deep periodontal scaling, produce high level bacteraemias. Recommendations to rationalize antibiotic prophylaxis for patients with artificial joints are presented.

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Antibiotic prophylaxis for patients with joint prostheses — still a dilemma for dental practitioners

Cited by 31 publications

References 24 publications

The impact of clinical audit on antibiotic prescribing in general dental practice

The impact of clinical audit on antibiotic prescribing in general dental practice

Premedication of Patients Undergoing Dental Procedures Causing Bacteremia after Total Joint Arthroplasty

Patients with artificial joints: do they need antibiotic cover for dental treatment?

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