In 2014, the ADA Council on Scientific Affairs assembled an expert panel to update and clarify the clinical recommendations found in the 2012 evidence report and 2013 guideline, Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
As was found in 2012, the updated systematic review undertaken in 2014 and published in 2015 found no association between dental procedures and prosthetic joint infections.3
Based on this evidence review, the 2015 ADA clinical practice guideline
"In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.”
A co-published editorial by Meyer4
"The new CSA guideline clearly states that for most patients, prophylactic antibiotics are not indicated before dental procedures to prevent [prosthetic joint infections]. The new guideline also takes into consideration that patients who have previous medical conditions or complications associated with their joint replacement surgery may have specific needs calling for premedication. In medically compromised patients who are undergoing dental procedures that include gingival manipulation or mucosal inclusion, prophylactic antibiotics should be considered only after consultation with the patient and orthopedic surgeon. For patients with serious health conditions, such as immunocompromising diseases, it may be appropriate for the orthopedic surgeon to recommend an antibiotic regimen when medically indicated, as footnoted in the new chair-side guide."
A 2017 commentary5
published in the February 2017 issue of JADA
written by ADA-appointed experts, offers guidance for using appropriate use criteria published by the American Academy of Orthopaedic Surgeons in January 20176
that address managing care for patients with orthopedic implants undergoing dental procedures. The JADA
editorial calls the appropriate use criteria "a decision-support tool to supplement clinicians in their judgment" and it emphasizes discussion of available treatment options between the patient, dentist and orthopedic surgeon, weighing the potential risks and benefits.The commentary encourages dentists to continue to use the 2015 guideline,3
consult the appropriate use criteria as needed, and respect the patient's specific needs and preferences when considering antibiotic prophylaxis before dental treatment. According to the ADA Chairside Guide
, in cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and, when reasonable, write the prescription.