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ADA, AAOS developing evidence-based guidelines for patients with orthopedic implants

Rosemont, Ill.—The ADA and American Academy of Orthopaedic Surgeons continue to work together to develop evidence-based, clinical practice guidelines for antibiotic prophylaxis for dental patients with orthopedic implants.

The new guidelines were initiated following a number of letters from the ADA to AAOS starting in late 2008 expressing concern over the AAOS decision to adopt a global prophylaxis statement without clinically relevant scientific input from the ADA.

"We believe the guidance for dental procedures contained in this document does not provide adequate information for dentists and will not facilitate the kind of communications between dentists and orthopedic surgeons that I’m sure you agree is desirable for them to provide for optimal patient care," wrote Dr. Michael Rethman, past CSA chair, in a letter to AAOS.

The new guidelines are expected to be completed later this year and released in 2012, will undergo a rigorous evidence-based approach by the AAOS, ADA and others who are participating in the work group put together by the AAOS Guidelines and Technology Oversight Committee that met in November 2010.

The work group, of which Dr. Rethman is now co-chair, includes eight dentists representing the ADA councils on Science, Education and Licensure, Practice and Dental Benefits, as well as orthopedic surgeons, pathologists and infectious disease specialists.

At its November meeting, the group identified key questions and is currently conducting an evidence-based systematic review of more than 1,100 studies relevant to developing the guidelines. The next meeting is scheduled for Oct. 15-16 in Rosemont, when the group is expected to finalize draft guidelines, which will be disseminated for internal review and followed by peer review.

"This is an important issue for all dentists and their patients," said ADA President Ray Gist. "Once completed, the guidelines will have an impact on patients receiving care from dentists. For this reason it's important to understand that the process used to develop these guidelines is rigorous. The recommendations must be supported by the results of scientifically sound, evidence-based systematic reviews."

In 2009, AAOS issued an information statement for patients undergoing certain medical and dental procedures who previously had a total joint replacement, saying, "Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia."

This was different from the previous AAOS guidelines, which recommended antibiotic prophylaxis only within the first two years following replacement surgery and beyond two years only for patients with co-morbidities that might place them at increased risk for hematogenous total joint infection (i.e. immunocompromised patients).

For more information about all AAOS guidelines and how they are developed, visit www.aaos.org/research and click on the section on guidelines.

The ADA always recommends that a dentist exercise his or her professional judgment when applying any guideline as necessary in any clinical situation.