Antibiotic prophylaxis for prosthetic joint patients undergoing invasive dental procedures: time for a re-think?

Background:

In the US, it has been common practice to recommend dentists provide antibiotic prophylaxis (AP) before invasive dental procedures (IDP) to prevent late peri-prosthetic joint infection (LPJI) in patients with prosthetic joints despite lack of evidence for a causal relationship between IDP and LPJI, and a lack of evidence for AP efficacy.

Methods:

A recent study quantified the IDP incidence over the 15-months prior to LPJI hospital-admissions in England for which dental records were available. A case-crossover analysis compared IDP incidence in the 3-months before LPJI admission with the preceding 12-months. The English population was used because guidelines do not recommend AP and any relationship between IDP and LPJI should be fully exposed.

Results:

No significant positive association was identified between IDP and LPJI. Indeed, the incidence of IDP was lower in the 3-months before LPJI hospital admission than in the preceding 12 months.

Conclusions:

In the absence of a significant positive association between IDP and LPJI, there is no rationale to administer AP before IDP in patients with prosthetic joints, particularly given the cost and inconvenience of AP, risk of adverse drug reactions and potential for unnecessary AP use that promotes antibiotic resistance. These results should re-assure orthopaedic surgeons and their patients that dental care of patients with prosthetic joints should focus on maintaining good oral hygiene rather than on recommending AP for IDP. Moreover, it should also re-assure those in other countries where AP is not recommended that such guidance is sufficient.