In December 2012, the American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA) collaboratively announced revised guidelines on the use of antibiotics as a means to prevent the infection of prosthetic joints.  The most recent guidelines no longer recommend the routine use of antibiotics in most cases of patients with artificial joints. This revision to existing best practices has been slow to reach the general public.  In summary, based on considerable research (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927664/), antibiotics before dental procedures has not been found to be beneficial for the vast majority of patients with artificial joints and in many cases can actually be harmful.

This topic comes up fairly often in the dental chair as many of my patients have artificial joints.  For years the guidelines have been moving toward the reduction of the use of prophylactic antibiotics before dental visits and the frequently changing opinions can often be confusing.  The idea was that bacteria can enter your bloodstream during invasive dental procedures that could, potentially, after a torturous path, end up making their way into the joint space, resulting in a harmful infection of that prosthetic joint.  If this theory were correct, the use of antibiotics as a means to prevent it could make sense.  However, after years of research, they cannot find any cases where this has actually happened.  At the same time, they have also found that simply brushing your teeth can also result in bacteria from your oral cavity entering your bloodstream; and yet, there are no recommendations for the use of preventive antibiotics before brushing teeth.  After years of ongoing research, the AAOS and ADA have finally eliminated the general recommendation for the use of antibiotics in the case of prosthetic joints.  Ultimately, however, their recommendation defers to the patient and their orthopedic surgeon to make the final decision.

If this topic applies to you, the Cascadia Dentistry team continues to defer to you and your surgeon and recommend that you talk with your surgeon about the revised guidelines.  In both personal experience and in doing our own research, we have found evidence that scaling down the overuse of antibiotics is beneficial, as instances where they are over-prescribed can reduce their effectiveness or even lead to life-threatening digestive issues.  As a result, we follow the guidelines of the ADA and the AAOS and do not routinely recommend the use of antibiotic prophylaxis for prosthetic joints.  If you have any questions or concerns, please let us know at your next dental visit. We would be more than happy to discuss this with you further.

To schedule an appointment, please call Cascadia Dentistry in Stanwood:  (360) 629-7229