Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
We, as dentists, are now involved in a controversy in which the potential good or harm which we place upon our patients may not come to be fully recognized for many years to come. The question revolves about the need to premedicate a patient who had a total joint arthroplasty regardless of how many years ago. There is a divergence between the recommendations of the American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA) regarding the need for antibiotic prophylaxis.
In 2009 the AAOS recommended clinicians consider antibiotic prophylactic coverage for all patients who had a total joint arthroplasty before having any invasive procedures that may cause bacteremia. Although I believe all of us would insist that our patients who had a total knee replacement requires antibiotic prophylaxis at every visit in which a bacteremia might develop, many applied the opinion that the need for antibiotic coverage for a patient who had a total hip replacement was not required two years after the procedure. Previous joint statements from the ADA and the AAOS did not indicate the consideration of antibiotic prophylaxis unless the patient was immunocompromised, had a previous prosthetic joint infection, or had a high-risk co morbid condition. The AAOS 2009 recommendations did not limit the time that had passed between the joint implantation and the invasive procedure. Of significance is the lack of definition of an invasive dental procedure that produces a transient bacteremia.
This change in the recommendation by AAOS could have an impact on how we practice. Currently 750,000 orthopedic joint replacement procedures are annually performed. The number of anticipated procedures is expected to significantly increase with the aging Baby Boomer population.
Health care providers are cautioned not to prescribe antibiotics unless they are truly needed. The ADA feels there is no need to follow the 2009 recommendations of the AAOS. What are you suppose to do?
As an oral and maxillofacial surgeon my procedures are considered invasive. I have spoken with orthopedic surgeons on many occasions (as recently as two weeks ago) regarding the question of the need for premedication. The consensus is ALL patients, regardless of knee, hip, shoulder replacement require antibiotic prophylaxis at ALL times.
It is a difficult decision each of us must make. Will today's decision look as bright in tomorrow's light? Until there is a complete agreement between the ADA and AAOS, I will pre-medicate.
WHAT WILL YOU DO?
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery