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Compendium

March 2013, Volume 34, Issue 3
Published by AEGIS Communications

Update to “Antibiotic Prophylaxis: A Literature Review”

In a letter to the Compendium editor dated March 1, 2013, from Eric T. Stoopler, DMD, FDS RCSEd, Associate Professor of Oral Medicine, Director, Postdoctoral Oral Medicine Program, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, and Thomas P. Sollecito, DMD, FDS RCSEd, Professor and Chairman of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, it was brought to our attention that an update should be noted regarding an article published online by Compendium. The article, “Antibiotic Prophylaxis: A Literature Review,” pp e33-e37, was part of the Compendium March Online Only issue.

Per Drs. Stoopler and Sollecito, while the article provides valuable information to oral healthcare providers (OHCPs) about antibiotic prophylaxis with significant clinical implications, it is imperative for OHCPs to be aware of new guidelines concerning antibiotic prophylaxis for patients with orthopaedic implants undergoing dental procedures. These guidelines were issued jointly from the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) in 2012,1 after the Compendium article had been scheduled for publication. These are the first jointly endorsed guidelines from the ADA and AAOS regarding orthopaedic implant prophylaxis for patients undergoing dental procedures since 2003.2 Three major recommendations have been issued in the 2012 guidelines, and OHCPs must be familiar with these in order to provide the most current evidence-based information to their patients (see Table). It is also important for OHCPs to understand that the 2012 guidelines regarding this matter supercede all previous guidelines issued by these organizations.

References

1. American Academy of Orthopaedic Surgeons; American Dental Association. Prevention of orthopaedic implant infection in patients undergoing dental procedures: evidence-based guideline and evidence report. 1st ed. American Academy of Orthopaedic Surgeons; Rosemont, IL: 2012. http://www.aaos.org/research/guidelines/PUDP/PUDP_guideline.pdf. Accessed March 15, 2013.

2. American Dental Association; American Academy of Orthopedic Surgeons. Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 2003;134(7):895-899.

Table. Major Recommendations from the 2012 ADA – AAOS guidelines for prevention of orthopaedic implant infection in patients undergoing dental proceduresa

Recommendation 1
The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.

Strength of Recommendation: Limited

A Limited recommendation means the quality of the supporting evidence that exists is unconvincing, or that well-conducted studies show little clear advantage to one approach versus another.

Practitioners should be cautious in deciding whether to follow a recommendation classified as Limited, and should exercise judgment and be alert to emerging publications that report evidence. Patient preference should have a substantial influencing role.

Recommendation 2
We are unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopaedic implants undergoing dental procedures.

Strength of Recommendation: Inconclusive

An Inconclusive recommendation means that there is a lack of compelling evidence resulting in an unclear balance between benefits and potential harm. Practitioners should feel little constraint in deciding whether to follow a recommendation labeled as Inconclusive and should exercise judgment and be alert to future publications that clarify existing evidence for determining balance of benefits versus potential harm. Patient preference should have a substantial influencing role.

Recommendation 3
In the absence of reliable evidence linking poor oral health to prosthetic joint infection, it is the opinion of the work group that patients with prosthetic joint implants or other orthopaedic implants maintain appropriate oral hygiene.

Strength of Recommendation: Consensus

A Consensus recommendation means that expert opinion supports the guideline recommendation even though there is no available empirical evidence that meets the inclusion criteria.

Practitioners should be flexible in deciding whether to follow a recommendation classified as Consensus, although they may set boundaries on alternatives. Patient preference should have a substantial influencing role.

a Adapted and modified from: American Academy of Orthopaedic Surgeons; American Dental Association. Prevention of orthopaedic implant infection in patients undergoing dental procedures: evidence-based guideline and evidence report. 1st ed. Published by the American Academy of Orthopaedic Surgeons; Rosemont, IL: 2012.