Antibiotic Prophylaxis Before Dental Procedures for Patients with Total Joint Replacements

Several weeks ago, a dentist asked whether one of my patients — a 75-year-old woman who had undergone total knee replacement 16 months ago — needed antibiotic prophylaxis prior to dental scaling and tooth extraction. Coincidentally, a new clinical practice guideline, produced jointly by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA), addresses this controversial topic (J Bone Joint Surg Am 2013; 95:745). Before I discuss the new guideline, a brief historical look at the controversy is in order.

In 2003, the ADA and AAOS issued an “Advisory Statement” on antibiotic prophylaxis for dental patients with total joint replacements (J Am Dent Assoc 2003; 134:895). According to this statement, “it is ad…