Australian Arthroplasty Society Position Statement on the use of prophylactic antibiotics for
dental procedures in patients with prosthetic joints.
The use of prophylactic antibiotics in patients with joint replacements undergoing dental procedures is controversial.
Several schools of thought exist:
• Some surgeons recommend the routine use of prophylactic antibiotics as there are rare cases where a patient
presents with a septic prosthesis and an oral organism is identified. They point to the evidence that brushing teeth
and dental instrumentation can cause a bacteraemia. It is felt that the risk posed by a dose of oral antibiotics is
low and therefore they should always be given when a patient with a prosthesis has a dental procedure.
• An alternate viewpoint is that antibiotics should not be given at all as the risk of developing sepsis from a dental
procedure is extremely low and that the evidence supporting the use of prophylactic antibiotics is lacking.
Furthermore such antibiotic administration may contribute to bacterial antibiotic resistance and the risk of
anaphylaxis from the antibiotic administration is higher than the risk of prosthetic infection.
• The middle ground is to give antibiotics when dental procedures are performed in the period immediately after
prosthesis implantation. This is based on the theory that there is a high-risk period in a freshly implanted
prosthesis when the prosthetic bone interface is maturing. This period is variously defined as between 3 and 12
months post surgery.
• It has been suggested that antibiotics might only be needed in “higher risk” situations such as major dental
procedures (an extraction or a root canal), in the immunocompromised host or in those with poor oral hygiene.
The American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) released a
combined Clinical Practice Guideline in 2013 following an extensive review of the available literature. They concluded
that there is a lack of evidence that a bacteraemia produced from dental treatment is linked to deep prosthetic
infection and there is a lack of evidence that the use of antibiotics prevents the development of deep prosthetic
infection.
The AAOS-ADA produced three recommendations and the level of supporting evidence was stated.
1. The practitioner considers changing the longstanding practice of prescribing prophylactic antibiotics for patients who
undergo dental procedures. (There is Limited evidence to support this practice)
2. No conclusion can be drawn for or against the use of topical antibiotics for patients who undergo dental procedures.
(Inconclusive evidence)
3. Patients should maintain good oral health (Consensus)
RECOMMENDATION
The Australian Arthroplasty Society agrees with this analysis and now recommends no routine antibiotic prophylaxis
be give to patients with joint prostheses undergoing dental procedures. In the immunocompromised patient or those with poor oral hygiene the surgeon is recommended to discuss the risk and benefits with his or her individual patient.
This is general advice and consideration should be given to individual patient circumstances.