Letters: Prosthetic joint patients
May 29, 2015
The article “Dentists, Physicians Provide Statements on Co-Treatment of Prosthetic Joint Patients in JADA”
(April 20 ADA News), reminded me that the issue regarding prophylaxis for arthroplasty patients is still ambiguous.
Antibiotic prophylaxis for arthroplasty patients prior to dental treatment is the greatest medico-legal conundrum I have faced in my nearly four decades of practicing dentistry. I have discovered that most orthopedic surgeons, as well as many dentists, are skeptical of the recommendations of the 2014 panel convened by the American Dental Association Council on Scientific Affairs, which published the evidence-based clinical practice guideline in the January issue of the Journal of the American Dental Association.
Although the ADA panel recommended that, in general, “prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection,” many orthopedic surgeons are still recommending their patients be covered under various circumstances. Additionally, many dentists have decided to continue to adhere to past regimens and have been influenced by the opinion of the American Academy of Orthopedic Surgery published most recently by Mary Ann Porucznik in the February issue of AAOS Now.
Help! I worry about the potential for a smart lawyer and compliant jury determining whether a dentist should be following the recommendations of the patient’s orthopedic surgeon (and the AAOS) or whether the guidelines of the January 2015 ADA clinical practice guideline should hold sway. Additionally, a conflict is posed by the choice of balancing the risk of a joint infection against the risk of an adverse drug reaction, the development of bacterial resistance and serious (and possibly fatal) sequellae such as pseudomembranous colitis — especially caused by Clostridium difficile.
I am sure many of us would appreciate clarity and advice. I, personally, feel that we, as dentists, are most responsible for our patients overall well being and are obligated to make our decisions with the ADA clinical practice guideline as our guide. I do not feel we should be abdicating our judgment to the more narrow concerns of orthopedic friends.
William W. Weller, D.D.S.