Christopher Omeltschenko, D.D.S.
6560 Colerain Ave., Cincinnati, OH 45239

Pre Med No Longer Recommended for Joint Replacement Patients

Premedication No Longer Recommended For Most Joint Replacement Patients

A Report from the American Dental Association Council on Scientific Affairs has determined that the use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints is no longer warranted for most people.

Clinical Recommendations: New Guidelines for the Use of Prophylactic Antibiotics in Patient with Prosthetic Joints

In general, for patients with prosthetic joint implants, prophylactic antibiotics are NOT recommended prior to dental procedures to prevent prosthetic joint infection.

For patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon.  To assess a patient’s medical status, a complete health history is always recommended when making final decisions regarding the need for antibiotic prophylaxis.

 Clinical Reasoning for the Recommendation:

  • There is evidence that dental procedures are not associated with prosthetic joint implant infections
  • There is evidence that antibiotics provided before oral care do not prevent prosthetic joint implant infections
  • There are potential harms of antibiotics including the risk of anaphylaxis, antibiotic resistance, and opportunistic infections like Clostridium difficile
  • The benefits of antibiotic prophylaxis may not exceed the harms for most patients
  • The individual patient’s circumstances and preferences should be considered when decided whether to prescribe antibiotics prior to dental procedures

Source: Sollecito TP et al.  The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints.  JADA 2015; 146: 11-68.e8

http://jada.ada.org/article/S0002-8177%2814%2900019-1/abstract

From this point forward we will no longer be requiring premedication for joint replacement patients unless it is requested and authorized by the orthopedic surgeon or their doctor.