Editorial: Antibiotic prophylaxis for dental patients with joint replacements: The ADA versus AAOS.

In 2012, The American Dental Association (ADA) in conjunction with the American Academy of Orthopaedic Surgeons (AAOS) issued an evidence-based guideline and evidence report with recommendations for prevention of orthopedic implant infection in patients undergoing dental procedures.1 In summary, there were three recommendations. The first recommendation was the practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with prosthetic hip and knee joint implants undergoing dental procedures. This was a limited grade recommendation. The second inconclusive grade recommendation dealt with their inability to recommend for or against use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopedic implants undergoing dental procedures. Finally, the third consensus grade recommendation supported maintenance of appropriate oral hygiene in patients with prosthetic joint implants. In January 2015, a report from the ADA Council on Scientific Affairs published a document that outlines the use of antibiotic prophylaxis prior to dental procedures in patients with prosthetic joints.2 This recommendation from the panel of experts declared that the best evidence (four case-control studies) from the literature (until 2014) including the 2012 publication of ADA/ AAOS led them to believe that there is no best evidence that demonstrates an association between dental procedures and prosthetic joint infection. Hence the recommendations were much different from the 2012 joint ADA/AAOS guidelines. This expert panel recommended against routine use of antibiotic prophylaxis Mel Mupparapu Antibiotic prophylaxis for dental patients with joint replacements: The ADA versus AAOS