From the Guidelines
Antibiotics are generally not required before dental surgery for patients with metal plates in their hands. The presence of orthopedic hardware like plates, screws, or pins in extremities does not typically necessitate antibiotic prophylaxis for dental procedures, as evidenced by the 2020 review of guidelines for dental antibiotic prophylaxis 1. This recommendation applies to most patients with well-healed implants placed more than three months ago.
Key Considerations
- The risk of prosthetic joint infection (PJI) is less than 1% 1, and the risk of adverse events from taking antibiotics is significantly higher, with 1 in 5 patients developing an antibiotic adverse event that requires a visit to the doctor or ER 1.
- The American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) have revised their guidelines to recommend against routine antibiotic prophylaxis for patients with prosthetic joints undergoing dental procedures, except for those with high-risk conditions such as compromised immune systems or history of PJI 1.
- The use of antibiotics can disrupt the gut microbiome, contribute to antibiotic resistance, and cause adverse drug reactions (ADRs) 1, including Clostridioides difficile (C. diff) infection, which can be life-threatening.
Exceptions and Special Considerations
- Patients with compromised immune systems, poorly controlled diabetes, or a history of prosthetic joint infections may require individualized assessment and consideration for antibiotic prophylaxis 1.
- The decision to use antibiotics should be made on a case-by-case basis, taking into account the patient's specific medical history, the type of dental procedure, and the potential risks and benefits of antibiotic prophylaxis.
Recommendations
- Patients with metal plates in their hands should discuss their individual risk factors and medical history with their dentist and orthopedic surgeon to determine the best course of action 1.
- In general, antibiotic prophylaxis is not recommended for patients with metal plates in their hands undergoing dental surgery, unless they have a high-risk condition or other factors that warrant its use 1.
From the Research
Antibiotics and Dental Surgery with Metal Plates
- The provided studies do not directly address the question of whether antibiotics are required before dental surgery if a patient has metal plates in their hand 2, 3, 4, 5, 6.
- The studies primarily focus on the use of antibiotics in patients undergoing total joint arthroplasty (TJA) or other surgical procedures, and do not mention dental surgery or metal plates in the hand.
- Study 2 discusses the use of extended oral antibiotic therapy after TJA, while study 3 evaluates the effectiveness of extended oral antibiotic prophylaxis in reducing infection rates after primary TJA in high-risk patients.
- Study 4 compares the effectiveness of different prophylactic antibiotics in preventing surgical site infections after arthroplasty, and study 5 discusses the Precautionary Principle in public health decision-making.
- Study 6 analyzes the concept of "absence of evidence" in forensic science, but does not relate to the use of antibiotics in dental surgery.
- There is no direct evidence to support or refute the requirement of antibiotics before dental surgery in patients with metal plates in their hand, based on the provided studies.