J Bone Jt Infect 2016; 1:42-49. doi:10.7150/jbji.16318
Antibiotic Prophylaxis During Dental Procedures in Patients with Prosthetic Joints
1. Department of Infectious Diseases, Bern University Hospital, University of Bern;
2. Institute for Infectious Diseases, Faculty of Medicine, University of Bern,
3. Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva;
4. Orthopedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva;
5. Infectious Diseases Service, Cantonal Hospital Zug, Baar;
6. Orthopedic Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne;
7. Clinic for Orthopedics and Trauma Surgery and Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland Liestal, Switzerland.
Sendi P, Uçkay I, Suvà D, Vogt M, Borens O, Clauss M. Antibiotic Prophylaxis During Dental Procedures in Patients with Prosthetic Joints. J Bone Jt Infect 2016; 1:42-49. doi:10.7150/jbji.16318. Available from http://www.jbji.net/v01p0042.htm
In patients with artificial joints, the need for antimicrobial prophylaxis during dental procedures is often raised. The present document describes the pathogenic mechanisms and epidemiological data on the subject of periprosthetic joint infections (PJI) after dental procedures. The document reflects the opinion and recommendations of the expert group 'Infection' of Swiss Orthopaedics.
Microorganisms belonging to oral flora can seed haematogenously to an artificial joint. The proof of a causative relation with dental procedures is not possible, because the responsible bacteraemia can originate from the oral cavity at any time, irrespective of when the dental procedure occurs. Good oral hygiene is associated with a lower risk for PJI. Transient bacteraemia occurs during daily oral hygiene activity (e.g., tooth brushing) and thus the cumulative risk for a haematogenous PJI from tooth brushing is higher than that from a dental procedure. PJI after a dental procedure are rarely reported. On the basis of an epidemiological model, several thousand patients with artificial joints must receive antimicrobial prophylaxis to prevent a single PJI. Considering this ratio, the number of adverse events due to the antimicrobial compound exceeds the benefit of administering it by a large magnitude. Therefore, as a rule for the vast majority of cases, antimicrobial prophylaxis during dental procedures is not recommended. It is important that a patient has a good oral health status before joint implantation and that good oral hygiene is continuously maintained in patients with artificial joints.
Keywords: periprosthetic joint infections, antimicrobial prophylaxis, dental procedure.