Case against antibiotic prophylaxis for dental treatment of patients with joint prostheses

General medicine and surgery for dental practitioners Part 8: Musculoskeletal system

“…In patients with prosthetic joint replacements there is no indication for antibiotic cover for dental treatment 6,7 but there is a suggestion of a degree of immunocompromise in rheumatoid arthritis and thus antibiotic cover may be wise for these patients. The same may be said of the patient with diabetes mellitus who has a prosthetic joint.…”

Review On Prophylactic Antibiotics For Dental Patients With Prosthetic Joints

“…Patients with total joint prosthesis and with acute orofacial infection should be vigorously treated as any other patient to eliminate the source of infection by incision and drainage, endodontics, extraction, and appropriate therapeutic antibiotics when indicated. Practitioners should always maintain a high index of suspicion for any unusual signs and symptoms, such as fever, swelling, pain, joint warm to touch, in patients with total joint prostheses (17,25,29). r Review on prophylactic antibiotics for dental patients with prosthetic joints 25…”

“…One is the recommendation by the Working Party of the British Society for Antimicrobial Chemotherapy (BSAC) in 1992 (25), and the other a joint statement by the American Dental Association and the American Academy of Orthopaedic Surgeons (ADA/AAOS) in 1997 (26).…”

No evidence to link prosthetic joint infections with dental procedures

“…The Working Party of the British Society for Antimicrobial Chemotherapy emphasised in 1992 4 that there was no evidence to support the use of antibiotic prophylaxis before dental work in patients with joint replacement, and yet the debate has rumbled on. With the significant change in practice being brought about by the NICE recommendations on antibiotic prophylaxis against infective endocarditis and the increasing concerns over antibiotic resistance, it is time to take note of the available evidence and stop providing people who have had hip and knee replacements with antibiotic prophylaxis for dental procedures.…”

“…Antibiotic prophylaxis is advised in patients with systemic immunosuppressive disease eg, diabetes (type I and II), rheumatoid arthritis, haemophilia or malignancy (either from the immunosuppressive effects of the malignancy or those of treatment). 4. Prophylaxis is clearly indicated where there is overt oral sepsis, eg, any kind of pre-existing oral infection which could lead to metastatic spread.…”