In 2016 the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) released an updated co-developed guideline, “Appropriate Use Criteria [use of prophylactic antibiotics] For the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures ,” a systematic review of existing clinical research published in peer-reviewed journals to determine the correlation between dental procedures and prosthetic joint infection (PJI).
- Adopted by the American Academy of Orthopaedic Surgeons Board of Directors 9/23/2016
- Approved by the American Dental Association Council on Scientific Affairs 10/24/2016
The 57 page document from the ADA and AAOS developed recommendations for the appropriateness for the use of antibiotics of each of the clinical indications for treatment as “Appropriate,” “May be Appropriate,” or “Rarely Appropriate.”
With this AUC, we have attempted to define clinical situations in which antibiotic prophylaxis in certain at-risk dental patients could reduce a theoretical risk of post-surgical prosthetic joint infection. This AUC was developed as a decision support tool to facilitate the treatment of defined “high risk” and “immune compromised” patients who are on the more severe end of the clinical spectrum of disease. In the absence of readily available laboratory data or suggestive clinical suspicion, it would be reasonable to assume that most patients will fall outside of these criteria and therefore lay outside the confines of our strict definitions. As always, sound judgment should guide clinical decisions about when it may be necessary or prudent to delay a dental procedure until more information is available.
AAOS Online Guideline Tool, click here
- Appropriate Use Criteria
- Management of Patients with Orthopaedic Implants Undergoing Dental Procedures
- Assumptions List: Planned Dental Procedures, Immunocompromised Status, and Glycemic Control
- Indication Profile with Procedure Recommendations
If you have a total joint replacement, and you have any question at all whether you should take an antibiotic for dental visits, please contact your orthopedic surgeon or family physician to advise you.