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/Institutions/University-of-Maryland-School-of-Dentistry/json/Clinic-Manual/Dental-Hygiene-Program.json

Total Joint Replacement:

Total Joint Replacement http://www.ada.org/en/member-center/oral-health- topics/antibiotic-prophylaxis#replace

In 2012, the American Dental Association and the American Academy of Orthopaedic Surgeons (AAOS) released the first co-developed evidence-based guideline on the Prevention of Orthopedic Implant Infection in Patients Undergoing Dental Procedures. The clinical practice guideline, with three recommendations, is based on a systematic review of the literature. The review found no direct evidence that dental procedures cause orthopedic implant infections.

The following is a summary of the recommendations of the AAOS-ADA clinical practice guideline, Prevention of Orthopedic Implant Infection in Patients Undergoing Dental Procedures. This summary does not contain rationales that explain how and why these recommendations were developed, nor does it contain the evidence supporting these recommendations. All readers of this summary are strongly urged to consult the full guideline and evidence report for this information (see link below). We are confident that those who read the full guideline and evidence report will see that the recommendations were developed using systematic evidence-based processes designed to combat bias, enhance transparency, and promote reproducibility.

This summary of recommendations is not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician, dentist and other healthcare practitioners.

The Guideline Recommendations:

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.

2. We are unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopedic 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.

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 orthopedic 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.

If you have any questions about these recommendations, please contact the ADA Division of Science via email. ADA members may also use the Association’s toll-free number and ask for x2878.

Additional Resources for ADA/AAOS Guidelines

• Full Guideline: Prevention of Orthopedic Implant Infection in Patients Undergoing Dental Procedures (PDF)
• Executive Summary: Prevention of Orthopedic Implant Infection in Patients Undergoing Dental Procedures (PDF)