The American Dental Association (ADA) is the professional society for dentists. The ADA’s official recommendations are as follows: “For patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.” They recommend abstaining from prophylactic antibiotics because they assert that there is no evidence that dental procedures are associated with PJIs. They also argue that there is no evidence to suggest that giving patients prophylactic antibiotics before dental procedures prevents PJIs. The ADA asserts that antibiotic resistance is a major concern, and the theoretical benefits are not enough to make up for this concern. However, they state that each patient should be considered individually, taking into account their personal risk factors.
American Academy of Orthopedic Surgeons (AAOS)
Just as the ADA is the professional society for American dentists, the AAOS is the professional society for orthopedic surgeons. They have released their own guidelines for surgeons when considering prophylactic antibiotics for dental procedures.
The AAOS states, “The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.” They allow more discretion on the part of the physician. They assert that there is compelling evidence that oral procedures cause bacteremia, and that this bacterial blood infection could infect the joint hardware, particularly in the first 2 years after joint replacement. However, they agree with the ADA that the evidence for prophylaxis is not very strong and that the number of patients who need to take antibiotics to prevent one infection is very high.
Unlike the ADA, the AAOS delves more deeply into the patients that are an exception to their recommendations. For example, they state that immunocompromised patients are a special group. Immunocompromised patients do not have as strong of an immune system as their peers for a variety of reasons. The AAOS immunocompromised exceptions include patients with HIV/AIDS, cancer patients on immunosuppressive chemotherapy with signs of illness, other disease processes for which the patient is receiving immunosuppressive medications, and bone marrow recipients in a certain time frame. They also encourage physicians to include diabetes when considering the risk for infection. People with diabetes are more likely to have infections with their elevated blood sugar and compromised vasculature.