February 2000 Bulletin

When total joint patient needs dental antibiotic

The Academy’s infections committee is reminding orthopaedic surgeons and dentists about the essential factors concerning antibiotic prophylaxis for dental patients with total joint replacements.

Kevin Garvin, MD, chairman of the infections committee, said that judging by the inquiries received about the Advisory Statement, which was developed by the American Dental Association and the Academy in 1997, "there seems to be a misunderstanding about who should get antibiotic prophylaxis before a dental procedure."

Arlen Hanssen, MD, associate professor of orthopaedic surgery, Mayo Clinic, Rochester, Minn., agrees. "Despite the specific nature of this statement, the interpretation of these recommendations has been inconsistent," he said in a paper on "The Use of Prophylactic Antimicrobial Agents During and After Hip Arthroplasty." He co-authored the paper with Douglas R. Osmon, MD, assistant professor of internal medicine, division of infectious diseases, Mayo Clinic.

"Antimicrobial prophylaxis for patients with a prosthesis, who have an invasive procedure which may be a potential source of bacteremia, is an extremely controversial issue," said Dr. Hanssen and Osmon in their research paper. " The rate of bacteremia after dental and other invasive procedures has been reported and, in general, the frequency and intensity of bacteremia is highest with oral procedures, lower with genito-urinary manipulation and lowest in association with gastrointestinal tract procedures."

Dr. Garvin and Dr. Hanssen say that in the first two years following total joint replacement, all dental patients who are undergoing an invasive procedure, such as dental extractions or dental implants, should have antibiotic prophylaxis. After two years, high-risk patients who are undergoing invasive procedures should have antibiotic prophylaxis. High-risk patients include those who are insulin-dependent diabetics, have had previous prosthetic infections or hemophilia.

No antibiotic prophylaxis is recommended for any patient with a total joint replacement–even a high-risk patient–who is undergoing a low risk dental procedure such as fluoride treatment, X-rays or othodontic appliance adjustment.

The Advisory Statement on Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements is in the "Library" section of the AAOS home page at http://www.aaos.org.

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