Evaluating the Need for Antibiotic Therapy for Dental Procedures on Patients with Joint Replacements.
By: Sharon Zastrow, RDH
Evidence-based practice incorporates three components: scientific evidence, clinician’s experience, and the patient’s values. All three of these elements should be incorporated into the decision-making process in an effort to improve patient care. Physicians, dentists and patients should work collaboratively to customize a treatment plan that is based on the evidence, clinical judgment and patient preferences.
The recommendation is founded in evidence that dental procedures are unrelated to periprosthetic joint infection (PJI) and that subsequent antibiotic prophylaxis does not reduce the risk for PJI. There is no conclusive evidence to support otherwise. High strength evidence suggests that antibiotic prophylaxis reduces the incidence of post-dental procedure related bacteremia, but there is no evidence that bacteremia increases the risk of PJI. Dental prophylaxis can be useful in reducing subsequent bacteremia, but bacteremia is a surrogate measure since no direct evidence exists linking bacteremia to PJI.
There is no direct evidence that oral topical antimicrobials prevent PJI following dental procedures.
Recommendation 3 is the only consensus recommendation in this Clinical Practice Guideline, and it addresses the maintenance of good oral hygiene. There is no direct evidence for this recommendation. In concordance with consensus recommendations, oral hygiene measures are low cost, provide potential benefit, are consistent with current practice, and are in accordance with good oral health.