New dental prophylaxis guideline

The American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA) have jointly published a clinical practice guideline regarding dental prophylaxis in patients with orthopedic implants. The recommendations, which are based on very limited evidence, state that, "the practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures." The guideline further states that they are unable to recommend for or against topical oral antibiotics in patients with implants, but they do recommend that patients with joint implants should "maintain appropriate oral hygiene," even though there is no evidence regarding this recommendation. This guideline does little to settle the debate between orthopedic surgeons, who often recommend lifetime dental prophylaxis, and infectious disease specialists who generally recommend against dental prophylaxis after 1 year. This rather weakly worded guideline is probably not the guidance most primary care physicians were hoping for, since they are generally responsible for prescribing prophylactic antibiotics and are responsible for possible adverse effects. The full guideline is available at www.aaos.org/research/guidelines/PUDP/dental_guideline.asp.