Oral antibiotics are often used prophylactically in patients undergoing invasive dental procedures, with the aim of preventing oral bacteria from entering the bloodstream, and causing serious complications due to infection among susceptible patients. Patients with prosthetic joints have historically been prescribed antibiotics prior to dental procedures. A 2014 survey found that 71% of Canadian dentists and 77% of orthopedic surgeons routinely prescribed prophylactic antibiotics for patients with total join arthroplasty prior to dental procedures. While this practice has been commonplace, it has been carried out with little supporting clinical evidence. Individuals who have undergone total joint replacement are considered to be at a generally higher risk of developing infection. Given the frequency with which dental procedures are performed, the potential for antimicrobial resistance, and potential cost, clinical effectiveness should be demonstrated. The present review was conducted as an update to a 2013 CADTH Rapid Response report on the same topic. The 2013 report identified one guideline that recommended practitioners could consider ceasing the routine use of antibiotics prior to dental procedures for patients with prosthetic joints. This review will seek to identify any recently published clinical evidence for the prophylactic use of oral antibiotics during dental procedures in patients with orthopedic implants and to review current evidence-based guideline recommendations for this patient group.
Copyright © 2016 Canadian Agency for Drugs and Technologies in Health.
- CONTEXT AND POLICY ISSUES
- RESEARCH QUESTIONS
- KEY FINDINGS
- SUMMARY OF EVIDENCE
- CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
- APPENDIX 1 Selection of Included Studies
- APPENDIX 2 Characteristics of Included Publications
- APPENDIX 3 Critical Appraisal of Included Publications
- APPENDIX 4 Additional References of Potential Interest
The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners--a report of the American Dental Association Council on Scientific Affairs.J Am Dent Assoc. 2015 Jan;146(1):11-16.e8. doi: 10.1016/j.adaj.2014.11.012. Epub 2014 Dec 18. J Am Dent Assoc. 2015. PMID: 25569493
Antibiotic prophylaxis and invasive dental treatment in prosthetic joint patients.N Z Med J. 2008 Aug 22;121(1280):45-52. N Z Med J. 2008. PMID: 18791627
Perioperative, postoperative, and prophylactic use of antibiotics in alloplastic total temporomandibular joint replacement surgery: a survey and preliminary guidelines.J Oral Maxillofac Surg. 2011 Aug;69(8):2106-11. doi: 10.1016/j.joms.2011.01.006. Epub 2011 Apr 5. J Oral Maxillofac Surg. 2011. PMID: 21470752
Routine prophylactic antibiotics for arthroplasty patients receiving dental care. Is it necessary?West Indian Med J. 2003 Dec;52(4):317-20. West Indian Med J. 2003. PMID: 15040070 Review.
Antimicrobial prophylaxis in noncardiac prosthetic device recipients.Hosp Pract (1995). 2012 Feb;40(1):44-74. doi: 10.3810/hp.2012.02.947. Hosp Pract (1995). 2012. PMID: 22406882 Review.