New Consensus Statement on Dental Patients with Total Joint Replacement
Dr. Susan Sutherland, Dentist-in-Chief at Sunnybrook Health Sciences Centre in Toronto and President of the Canadian Association of Hospital Dentists, speaks to Dr. John O’Keefe about the work that led to the updated Consensus Statement on Dental Patients with Total Joint Replacement.
Access the updated Consensus Statement on Dental Patients with Total Joint Replacement
Highlights
Dr. Sutherland discusses the revised position statement on total joint prophylaxis.
The previous position statement was clarified to remove any ambiguity and confusion for dental practitioners. The statement has been endorsed and branded by the Canadian Orthopedic Association, Canadian Dental Association and the Association for Infection Disease and Medical Microbiology.
Essentially, no antibiotic prophylaxis is required for patients with prosthetic joints.
Presently, there is now a unified consensus on the need for antibiotic prophylaxis amongst the three organizations based on sound scientific evidence to guide practice and achieve the best outcome for patients.
Are there exceptions that dentists should consider that might lead them to prescribe prophylactic antibiotics for patients with prosthetic joints?
As with any sort of guidance document, individual practitioners will consider the best available evidence, patient values and expectations and their own clinical expertise. The statement reflects the best available evidence, but is not prescriptive.
There are times when prophylactic antibiotics are indicated in dentistry, either based on the type of surgical procedure (for example, the literature suggests that a single pre-op loading dose is effective for reducing surgical site infections for partial and full bony impacted third molars and for reducing failure of implants and bone grafts) ) or the patient’s medical status (for example, urgent dental extractions in the face of chemotherapy induced neutropenia or for patients with a prosthetic heart valves).
However, it is NOT the presence or absence of a prosthetic joint that guides this decision, since there is a lack of evidence of associating dental procedures with prosthetic joint infection (PJI), the majority of which are caused by staph organisms and a corresponding lack of evidence supporting antimicrobial prophylaxis for preventing PJI.
Thanks for the great interview. This mostly clarifies things for me. However, can you please comment on whether or not antibiotics should be use AT ALL just after joint replacement surgery OR should we not treat when possible for some timeframe?
Thanks again!
It is reasonable to defer elective surgery after any major surgical procedure until the patient has recovered sufficiently to attend the office and sit comfortably in the dental chair.
However, antibiotics should not be used on the basis of a recent total joint replacement. There is a lack of evidence of associating dental procedures with prosthetic joint infection (PJI), and a corresponding lack of evidence supporting antimicrobial prophylaxis for preventing PJI.
There are times when prophylactic antibiotics are indicated in dentistry, either based on the type of surgical procedure (I would refer you to the excellent presentation on OASIS by Dr. Nicholas Makhoul earlier this summer) or the patient’s medical status (for example, urgent dental extractions in the face of chemotherapy induced neutropenia or a patient with a prosthetic heart valve). However, it is NOT the presence or absence of a prosthetic joint that guides this decision in any way.
Thanks for the extra info! There are still Orthopaedic surgeons that want antibiotic coverage and I was just faxed a standard letter to patients from a big hospital requesting just that.
Thank you Susan for the comments on consensus on prophlactic antibiotic use.
On another subject, you refer to the literature mentioning effectiveness of loading doses or single doses prior to or after dental surgery.
Could you please provide the references or published reviews for this?
Thank you,