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January 2, 2013

Prevention of Infections in Artificial Joints From Dental Procedures: 2012 Scientific Statement

Filed under: Uncategorized — tntadmin @ 3:12 pm

Patients with artificial hips and knees can sometimes develop infections of these joints. These infections can be very serious, and it has been thought that dental procedures can cause such infections since dental procedures can cause “bacteremia” or short episodes of bacteria in the bloodstream. Some physicians and dentists have recommended that antibiotics be administered before dental procedures (“antibiotic prophylaxis”) in hopes of preventing such infections, but others have pointed out that there is little or no evidence that dental procedures cause artificial joint infections or that antibiotic prophylaxis can prevent them.

There is also a small, but significant, risk of harm from an unnecessary antibiotic. I have written articles about this controversial topic since 1995 (“Myths of prosthetic joint infections” in the journal Clinical Infectious Diseases), calling for an end to the practice of antibiotic prophylaxs in such patients. Now the American Academy of Orthopaedic Surgeons and the American Dental Assocaition have questioned this practice also.

After convening a group of distinguished physicians and dentists to review the available scientific evidence, the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) have issued a joint statement (no pun intended) in December 2012. It can be accessed at http://www.aaos.org/Research/guidelines/PUDP/PUDP_guideline.pdf

A summary of the statement can be found at http://www.aaos.org/Research/guidelines/PUDP/DentalSummofRec.pdf

The conclusion is that there is no evidence that dental procedures are related to artificial joint infections and that prophylactic antibiotics do not reduce the risk of artificial joint infections. The AAOS and ADA recommend that dentists and physicians consider discontinuing the routine prescribing of prophylactic antibiotics for patients with artificial joints. On the other hand, good oral health and hygiene is encouraged in patients with artificial joints.

Please share any concerns or questions with us (and your physician) about this important issue.

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