Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England

Abstract

Importance: Dentists in the United States are under pressure from orthopedic surgeons and their patients with prosthetic joints to provide antibiotic prophylaxis before invasive dental procedures (IDP) to reduce the risk of late prosthetic joint infection (LPJI). This has been a common practice for decades, despite a lack of evidence for an association between IDP and LPJI, a lack of evidence of antibiotic prophylaxis efficacy, cost of providing antibiotic prophylaxis, and risk of both adverse drug reactions and the potential for promoting antibiotic resistance.

Objective: To quantify any temporal association between IDP and subsequent LPJI.

Design, setting, and participants: This cohort study used a case-crossover and time trend design to examine any potential association between IDP and LPJI. The population of England (55 million) was chosen because antibiotic prophylaxis has never been recommended to prevent LPJI in England, and any association between IDP and LPJI would therefore be fully exposed. All patients admitted to hospitals in England for LPJI from December 25, 2011, through March 31, 2017, and for whom dental records were available were included. Analyses were performed between May 2018 and June 2021.

Exposures: Exposure to IDP.

Main outcomes and measures: The main outcome was the incidence of IDP in the 3 months before LPJI hospital admission (case period) compared with the incidence in the 12 months before that (control period).

Results: A total of 9427 LPJI hospital admissions with dental records (mean [SD] patient age, 67.8 [13.1] years) were identified, including 4897 (52.0%) men and 4529 (48.0%) women. Of these, 2385 (25.3%) had hip prosthetic joints, 3168 (33.6%) had knee prosthetic joints, 259 (2.8%) had other prosthetic joints, and 3615 (38.4%) had unknown prosthetic joint types. There was no significant temporal association between IDP and subsequent LPJI. Indeed, there was a lower incidence of IDP in the 3 months prior to LPJI (incidence rate ratio, 0.89; 95% CI, 0.82-0.96; P = .002).

Conclusions and relevance: These findings suggest that there is no rationale to administer antibiotic prophylaxis before IDP in patients with prosthetic joints.

Figure 1.. Monthly Incidence of Different Types of Dental Procedure During 15 Months Before Late Prosthetic Joint Infection (LPJI) Hospital Admission

Dotted lines show the linear trend for the case-crossover study control period (months 4-15 before LPJI admission, dashed lines of the same color). The control period trend lines have been extended through the case period (months 1-3) to allow comparison between the control period trend and any changes in the incidence of dental procedures in the case period. IDP indicates invasive dental procedure.

Figure 2.. Monthly Incidence of Invasive Dental Procedures During 15 Months Before Admission to Hospital With Late Prosthetic Joint Infection (LPJI)

Dotted lines show the linear trend for the case-crossover study control period (months 4-15 before LPJI admission, dashed lines of the same color). The control period trend lines have been extended through the case period (months 1-3, solid lines of the same color) to allow comparison between the control period trend and any changes in the incidence of dental procedures in the case period.

Figure 3.. Monthly Incidence of Noninvasive Dental Procedures During 15 Months Before Admission to Hospital With Late Prosthetic Joint Infection (LPJI)

Dotted lines show the linear trend for the case-crossover study control period (months 4-15 before LPJI admission, dashed lines of the same color). The control period trend lines have been extended through the case-period (months 1-3, solid lines of the same color) to allow comparison between the control period trend and any changes in the incidence of dental procedures in the case period.