Dentists face the expectations of orthopedic surgeons and patients with prosthetic joints to provide antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to reduce the risk of late periprosthetic joint infections (LPJIs).

Researchers have found in a new study that there is no association between invasive dental procedures and the subsequent development of late periprosthetic joint infections.

The study has been published in The Journal of the American Dental Association.
Dentists face the expectations of orthopedic surgeons and patients with prosthetic joints to provide antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to reduce the risk of late periprosthetic joint infections (LPJIs), despite the lack of evidence associating IDPs with LPJIs, lack of evidence of AP efficacy, risk of AP-related adverse reactions, and potential for promoting antibiotic resistance. The authors aimed to identify any association between IDPs and LPJIs and whether AP reduces LPJI incidence after IDPs.
The authors performed a case-crossover analysis comparing IDP incidence in the 3 months immediately before LPJI hospital admission (case period) with the preceding 12-month control period for all LPJI hospital admissions with commercial or Medicare supplemental or Medicaid health care coverage and linked dental and prescription benefits data.
Results
•Overall, 2,344 LPJI hospital admissions with dental and prescription records were identified. Patients underwent 4,614 dental procedures in the 15 months before LPJI admission, including 1,821 IDPs (of which 18.3% had AP).
• The analysis identified no significant positive association between IDPs and subsequent development of LPJIs and no significant effect of AP in reducing LPJIs.
The authors identified no significant association between IDPs and LPJIs and no effect of AP cover of IDPs in reducing the risk of LPJIs. In the absence of benefit, the continued use of AP poses an unnecessary risk to patients from adverse drug reactions and to society from the potential of AP to promote development of antibiotic resistance. Dental AP use to prevent LPJIs should, therefore, cease.
Reference:
Martin H. Thornhill, Teresa B. Gibson, Cory Pack, Peter B. Lockhart, Bryan Springer, Larry M. Baddour, et al. Quantifying the risk of prosthetic joint infections after invasive dental procedures and the effect of antibiotic prophylaxis. Published:December 02, 2022DOI:https://doi.org/10.1016/j.adaj.2022.10.00
Keywords:
Prosthetic joints, antibiotic prophylaxis, guidelines, prevention, dental procedures, The Journal of the American Dental Association,Martin H. Thornhill, Teresa B. Gibson, Cory Pack, Peter B. Lockhart, Bryan Springer, Larry M. Baddour