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ANTIBIOTIC PROPHYLAXIS FOR ORTHOPEDIC PATIENTS

The use of antibiotics prior to dental treatment for specific patients as recommended by dentists or physicians is called antibiotic prophylaxis.

Many dental procedures, and even daily activities like brushing and flossing, can allow the bacteria present in the mouth to enter the bloodstream. For most healthy patients, this bacteremia is not problematic since the immune system prevents these bacteria from causing any harm. However, for certain people there is a concern that this bacteremia could cause a dangerous infection elsewhere in the body.

Guidelines for Patient Selection:

In the past, antibiotic prophylaxis was suggested within the first two years of an artificial joint placement and for select patients with orthopedic implants such as metal pins, rods, screws, or plates. However, in 2012 the American Dental Association (ADA) and American Association of Orthopedic Surgeons (AAOS) updated these recommendations.

The new guidelines do not recommend routinely prescribing antibiotics prior to dental treatment for patients with artificial joints. Therefore, healthcare providers are currently relying more on individual assessment and consultation with patients to determine when antibiotic prophylaxis is advisable.

Patients with compromised immune systems are at greatest risk for implant infection and therefore are most likely to benefit from antibiotic prophylaxis. The following examples are suggestive of immunosuppression:

Reason for Change in the Guidelines:

The antibiotic prophylaxis guidelines are reviewed every few years to ensure that they are based on the best scientific evidence. The most recent reviews have shown no evidence that taking antibiotics before dental treatment prevents infections of artificial joints or orthopedic implants. Therefore, for most people, the potential for side effects and/or allergic reactions when taking antibiotics may outweigh the uncertain benefits.

Please help us to ensure your safe treatment in our office. Depending on your past and present medical conditions, we may require a physician’s letter indicating whether or not antibiotic prophylaxis is recommended.  It is ultimately your physician’s decision whether these guidelines are appropriate for your specific condition, and your willingness to help us obtain this information is appreciated.

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