From the Guidelines
Antibiotic prophylaxis is not recommended for patients with orthopedic implants undergoing routine dental cleaning procedures, as the risk of prosthetic joint infection is extremely low and the potential harms of antibiotic use outweigh the benefits. The current evidence, including a well-conducted case-control study 1, suggests that dental procedures, with or without antibiotic prophylaxis, are not associated with an increased risk of prosthetic hip or knee infections. While there is evidence that dental procedures can cause bacteremia, there is no direct link between dental procedure-associated bacteremia and infection of prosthetic joints or other orthopaedic implants 1. Some key points to consider include:
- The risk of developing a prosthetic joint infection from dental procedures is extremely low for patients with normal immune function and standard joint replacements.
- The potential harms of antibiotic use, including allergic reactions, antibiotic resistance, and side effects, outweigh the benefits for most patients.
- Prophylaxis may be considered in specific high-risk situations, such as patients with immunocompromise, previous prosthetic joint infection, inflammatory arthropathies, or those within the first 3-6 months after joint replacement surgery.
- Maintaining good oral hygiene is more important for preventing infection than prophylactic antibiotics for routine dental care, as stated in the opinion statement for recommendation 3 1. The decision to use antibiotic prophylaxis should be made through shared decision-making between the orthopedic surgeon, dentist, and patient, considering individual risk factors.
From the FDA Drug Label
The prophylactic administration of Cefazolin for Injection, USP preoperatively, intraoperatively, and postoperatively may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures which are classified as contaminated or potentially contaminated (e.g., vaginal hysterectomy and cholecystectomy in high-risk patients such as those older than 70 years, with acute cholecystitis, obstructive jaundice, or common duct bile stones). The prophylactic administration of Cefazolin for Injection, USP also may be effective in surgical patients in whom infection at the operative site would present a serious risk (e.g., during open-heart surgery and prosthetic arthroplasty).
The recommended antibiotic prophylaxis after orthopedic surgery is not explicitly stated for patients undergoing dental cleaning.
- Key points:
- The FDA label does not provide information on the use of cefazolin for antibiotic prophylaxis in patients undergoing dental cleaning after orthopedic surgery.
- The label discusses the use of cefazolin for perioperative prophylaxis in surgical procedures, but does not specifically address dental cleaning. 2
From the Research
Antibiotic Prophylaxis after Orthopedic Surgery for Dental Cleaning
- The use of antibiotic prophylaxis in patients with orthopedic prostheses undergoing dental cleaning is a topic of debate, with some studies suggesting that it may not be necessary 3.
- According to a study published in 1993, antibiotics are not necessary in most patients with prosthetic joints who are undergoing dental procedures 4.
- A systematic review published in 2022 found no evidence to suggest a relationship between dental implant surgeries and an increased risk of orthopedic prosthesis infection, and therefore, prophylactic antibiotics are not justified in these patients 3.
- However, when antibiotic prophylaxis is recommended, first-generation cephalosporins such as cefazolin are considered the preferred agents due to their excellent activity against staphylococci, which account for approximately 70% of postoperative infections in orthopedic prosthetic surgery 5, 6, 7.
- In cases where methicillin-resistant staphylococci are a concern, glycopeptide antibiotics such as vancomycin and teicoplanin may be used for prophylaxis, particularly in hospitals with high methicillin-resistance among these pathogens 5, 7.