Dentists prescribe roughly 10% of all outpatient antibiotics in the US.1 Many of those antibiotic prescriptions will not be wanted based mostly on present pointers. Research present that sufferers with complete joint substitute (TJR) generally obtain pointless antibiotic prophylaxis [PDF – 1 Page] regardless of scientific follow pointers from the American Dental Affiliation (ADA) and American Academy of Orthopaedic Surgeons (AAOS) that advocate in opposition to utilizing antibiotics to stop late prosthetic joint an infection normally.2
When you might have a dental process, micro organism in your mouth can enter your bloodstream. This additionally occurs throughout regular each day actions, reminiscent of brushing and flossing your enamel. For most individuals, the immune system kills the micro organism and prevents them from inflicting an infection some other place within the physique. Nonetheless, folks with sure underlying medical circumstances are at elevated danger of an infection and should have to take an antibiotic earlier than some dental procedures. Taking an antibiotic to stop an an infection known as antibiotic prophylaxis [PDF – 1 Page].
Previously, antibiotic prophylaxis was generally prescribed to sufferers with prosthetic joints earlier than sure dental procedures to stop joint infections. Nonetheless, skilled pointers now not advocate pre-dental process antibiotic prophylaxis for many sufferers with prosthetic joints. It’s because research have proven that antibiotics given earlier than dental procedures don’t forestall prosthetic joint infections and might result in unwanted side effects and the event of antimicrobial resistance. Sufferers who produce other indications for dental antibiotic prophylaxis ought to proceed to obtain antibiotics. Discuss to a healthcare skilled about when antibiotics are wanted.
And rising proof means that dental procedures (each invasive and non-invasive) pose no better danger for bacteremia for sufferers with TJR than actions of each day residing, reminiscent of brushing enamel or consuming.3-6 Thus, the dangers of antibiotic prophylaxis, together with opposed drug reactions and the specter of antimicrobial resistance, outweigh the potential profit for many sufferers.
The collaboration wanted between orthopedic surgeons, dentists, and sufferers to enhance antibiotic use hit house when my father had double knee replacements in 2023. His surgeon needed to prescribe dental prophylaxis despite the fact that my dad didn’t have particular comorbidities or a historical past of postoperative joint an infection to warrant antibiotics. I spent 6 months advocating on my father’s behalf earlier than his surgeon and workforce have been persuaded to alter their antibiotic prescribing habits. Sure, it was a number of effort, nevertheless it was price it once I take into consideration the potential lives saved by decreasing the usage of pointless antibiotics.
Antibiotic stewardship for the dental setting
Antibiotic stewardship is important for affected person security and combating antimicrobial resistance. Stewardship goals to optimize the remedy of infections by guaranteeing the usage of antibiotics for the right analysis, dose, period, and timing. Nonetheless, antibiotic stewardship in follow is greater than a scientific choice. It’s a cohesive effort to have interaction the dental workforce, medical professionals, and sufferers in a dedication to make use of antibiotics solely when crucial based mostly on one of the best proof out there for decision-making.
As a part of the Affiliation for Dental Security (ADS) workforce, I work to create and disseminate antibiotic stewardship content material. ADS was capable of design and launch an Antibiotic Stewardship web site for dental prescribers, workforce members, and sufferers utilizing funding offered by the Facilities for Illness Management and Prevention (CDC).7 The web site affords curated sources for dentists together with toolkits, templates, chart audit instruments, and checklists, communication supplies reminiscent of movies and podcasts, free persevering with training programs, and extra – all designed to advertise finest practices in dental antibiotic prescribing to create a secure setting for sufferers.
How can the dental workforce enhance antibiotic prescribing for sufferers with TJR?
- Keep updated on present dental prophylaxis pointers for sufferers with TJR, from the ADA and AAOS.8-9
- Collaborate with the orthopedic surgeon and contain the affected person in shared decision-making when deciding if antibiotic prophylaxis is required.
–Dentists and the dental workforce might entry a one-page info sheet [PDF – 1 Page] that can be utilized when speaking with sufferers and a letter template [doc] to share this up to date info with orthopedic surgeons of their follow community.10 - Share success tales and finest practices for optimizing antibiotic prescribing within the dental setting.
–ADS has issued a nationwide name for fulfillment tales, finest practices, and analysis on antibiotic stewardship in dentistry to be offered at its 3rd annual Antibiotic Stewardship Summit. The deadline for the decision is October 1, 2024.11 Please contemplate making use of.
I imagine we’ve an incredible alternative to enhance affected person care and save lives by altering prescribing behaviors and optimizing how we use antibiotics within the dental setting.
- Ramanathan S, Yan CH, Hubbard C, Calip GS, Sharp LK, Evans CT, Rowan S, McGregor JC, Gross AE, Hershow RC, Suda KJ. Adjustments in antibiotic prescribing by dentists in the US, 2012-2019. Infect Management Hosp Epidemiol. 2023 Nov;44(11):1725-1730. doi: 10.1017/ice.2023.151. Epub 2023 Aug 22. PMID: 37605940; PMCID: PMC10665869.
- Sollecito TP, Abt E, Lockhart PB, et al. The usage of prophylactic antibiotics previous to dental procedures in sufferers with prosthetic joints: evidence-based scientific follow guideline for dental practitioners–a report of the American Dental Affiliation Council on Scientific Affairs. J Am Dent Assoc 2015; 146:11–6 e8
- Springer BD, Baddour LM, Lockhart PB, Thornhill MH. Antibiotic Prophylaxis for Prosthetic Joint Sufferers Present process Invasive Dental Procedures: Time for a Rethink? J Arthroplasty. 2022 Jul;37(7):1223-1226. doi: 10.1016/j.arth.2022.02.014. Epub 2022 Feb 11. PMID: 35158002.
- Simon SJ, Aziz AA, Coden GS, Smith EL, Hollenbeck BL. Antibiotic Prophylaxis Previous to Dental Procedures After Complete Hip and Knee Arthroplasty Does Not Lower the Threat of Periprosthetic Joint An infection. J Arthroplasty. 2024 Feb 22:S0883-5403(24)00145-1. doi: 10.1016/j.arth.2024.02.046. Epub forward of print. PMID: 38401610.
- Thornhill MH, Gibson TB, Pack C, Rosario BL, Bloemers S, Lockhart PB, Springer B, Baddour LM. Quantifying the danger of prosthetic joint infections after invasive dental procedures and the impact of antibiotic prophylaxis. J Am Dent Assoc. 2023 Jan;154(1):43-52.e12. doi: 10.1016/j.adaj.2022.10.001. Epub 2022 Dec 2. PMID: 36470690.6.
- Thornhill MH, Crum A, Rex S, Stone T, Campbell R, Bradburn M, Fibisan V, Lockhart PB, Springer B, Baddour LM, Nicholl J. Evaluation of Prosthetic Joint Infections Following Invasive Dental Procedures in England. JAMA Netw Open. 2022 Jan 4;5(1):e2142987. doi: 10.1001/jamanetworkopen.2021.42987. PMID: 35044470; PMCID: PMC8771300.
- https://www.myads.org/antibiotic-stewardship. Accessed July 26, 2024.
- https://jada.ada.org/article/S0002-8177(14)00019-1/fulltext. Accessed August 5, 2024.
- https://www.aaos.org/globalassets/quality-and-practice-resources/dental/pudp_guideline.pdf [PDF – 1 Page]. Accessed August 5, 2024.
- https://www.myads.org/antibiotic-stewardship-for-prescribers. Accessed July 26, 2024.
- https://www.myads.org/call-for-antibiotic-stewardship-program-spotlight-research. Accessed July 26, 2024.
Extra on this subject: Dental Antibiotic Stewardship Assets Bundle
Erinne Kennedy, DMD, MPH, MMSc, is an Assistant Professor and Assistant Dean for Curriculum and Built-in Studying at Kansas Metropolis College School of Dental Medication in Joplin, Missouri. Dr. Kennedy has in depth dental public well being experience and serves as a nationwide antibiotic stewardship spokesperson for the American Dental Affiliation and advisor for the Affiliation for Dental Security (previously often called OSAP).
