For the vast majority of my dental career usual and customary treatment procedures called for certain patients who were at risk for bacterial infections to be medicated with a large dose of antibiotics an hour before a dental appointment. The theory was that the presence of the antibiotic within the patient’s system would help ensure that bacteria gaining access to the bloodstream during dental treatment would not contribute to the onset of infection. The majority of these so called ‘at risk’ patients had either a cardiac concern or an artificial knee or hip joint.
In April of 2007 the American Heart Association announced a major shake-up in their recommendations. The AHA reports that their new guidelines “are based on a growing body of scientific evidence that shows that, for most people, the risks of taking prophylaxis antibiotics for certain procedures outweigh the benefits… The new guidelines show taking preventive antibiotics is not necessary for most people and, in fact, might create more harm than good. Unnecessary use of antibiotics could cause allergic reactions and dangerous antibiotic resistance.
Only the people at greatest risk of bad outcomes from infective endocarditis — an infection of the heart's inner lining or the heart valves — should receive short-term preventive antibiotics before common, routine dental and medical procedures.
While the new AHA guidelines have made life easier for millions of patients there continues to be a foggy gray area surrounding this issue of antibiotic premedication and dental patients who have surgically placed prosthetic/artificial joints. Still today dentists and orthopedic surgeons are living by the policy updated most recently in 2009 by the American Academy of Orthopaedic Surgeons. The policy specifically states, “Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia (bacteria in the bloodstream).”
The wonderful news is that the American Dental Association and the American Academy of Orthopaedic Surgeons are working together to follow in the footsteps of the American Heart Association. The joint effort is intended to forge true evidence-based clinical practice guidelines for antibiotic prophylaxis for dental patients with total joint replacement. “We thought it was time that we really looked at the evidence,” says Charles M. Turkelson, PhD, director of the AAOS Department of Research and Scientific Affairs. “This is an issue that we know jointly affects the ADA and the AAOS so we should work on it together.” Dr. Dan Meyer, senior vice-president of ADA Science/Professional Affairs recognized that “This issue has significant health implications for the patients receiving care from both orthopedic surgeons and dentists. It is imperative to communicate the most appropriate guidance for providers and patients and essential that the clinical recommendations be supported by evidence-based systematic reviews that are scientifically sound.”
The new guidelines are expected in 2011. That my friends, is wonderful news!
Dr. Davis is especially good with kids. And his staff? Helpful, compassionate, and caring. They take care of business for you. Thumbs up. 10 on a scale of 5.