From the Guidelines
Antibiotic prophylaxis is generally not recommended for routine dental cleanings in patients with orthopedic implants or joint hardware. Current guidelines from major dental and orthopedic organizations, as outlined in the 2020 review of guidelines for dental antibiotic prophylaxis 1, no longer support routine antibiotic prophylaxis for most patients with prosthetic joints. The risk of prosthetic joint infection from dental procedures is extremely low, and the potential harms of unnecessary antibiotic use (including adverse reactions, drug interactions, and antimicrobial resistance) outweigh the benefits for most patients.
Key Considerations
- The risk of developing an antibiotic adverse event is significantly higher (1 in 5 patients) compared to the risk of prosthetic joint infection (<1%) 1.
- Patients with compromised immune systems, such as those with cancer, chemotherapy, or chronic steroid use, might be at greater risk for implant infections, and their surgeons may consider antibiotics before dental procedures.
- The decision to use prophylaxis should be made through consultation between the patient's dentist and orthopedic surgeon, considering individual risk factors rather than applying a universal approach.
High-Risk Patients
For specific high-risk patients, such as those with immunocompromised status, previous prosthetic joint infections, or certain systemic diseases like uncontrolled diabetes, prophylaxis may be considered on a case-by-case basis. In these situations, the typical regimen would be amoxicillin 2g orally taken 1 hour before the dental procedure. For patients with penicillin allergies, alternatives include clindamycin 600mg, azithromycin 500mg, or clarithromycin 500mg, also taken orally 1 hour before the procedure, as suggested by the 2017 AAOS/ADA guidelines 1.
Evidence Summary
The evidence from recent studies, including the 2020 review 1 and the 2013 study on prevention of orthopaedic implant infection in patients undergoing dental procedures 1, supports the notion that routine antibiotic prophylaxis for dental cleanings in patients with joint hardware is not recommended due to the low risk of prosthetic joint infection and the potential harms of unnecessary antibiotic use.
From the Research
Antibiotic Prophylaxis for Teeth Cleaning in Patients with Joint Hardware
- The American Dental Association Council on Scientific Affairs developed an evidence-based clinical practice guideline on the use of prophylactic antibiotics in patients with prosthetic joints who are undergoing dental procedures 2.
- The guideline states that, in general, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection, unless there are significant medical risks or clinical circumstances that suggest otherwise 2.
- The decision to use antibiotic prophylaxis should be based on the practitioner's professional judgment and the patient's needs and preferences, taking into account the risks of frequent or widespread antibiotic use 2.
- Other studies have focused on the management of prosthetic joint infections, including the use of suppressive antibiotic therapy, but do not provide specific recommendations for antibiotic prophylaxis prior to dental procedures 3, 4, 5.
- A recent review of antibiotic prophylaxis in dentistry notes that the guidelines have been changed over the years, and the list of medical conditions requiring antibiotic prophylaxis has been shortened considerably in the context of antibiotic resistance and unnecessary antibiotic prescription 6.
Recommended Antibiotic Prophylaxis
- There is no specific recommendation for antibiotic prophylaxis for patients with joint hardware undergoing teeth cleaning, as the current best evidence fails to demonstrate an association between dental procedures and prosthetic joint infection 2.
- However, the practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis 2.