Dentists prescribe roughly 10% of all outpatient antibiotics in the US.1 Many of those antibiotic prescriptions might not be wanted primarily based on current pointers. Research present that sufferers with complete joint alternative (TJR) generally obtain pointless antibiotic prophylaxis [PDF – 1 Page] regardless of scientific observe pointers from the American Dental Affiliation (ADA) and American Academy of Orthopaedic Surgeons (AAOS) that suggest in opposition to utilizing antibiotics to forestall late prosthetic joint an infection most often.2
When you could have a dental process, micro organism in your mouth can enter your bloodstream. This additionally occurs throughout regular each day actions, akin to brushing and flossing your enamel. For most individuals, the immune system kills the micro organism and prevents them from inflicting an infection some place else within the physique. Nonetheless, individuals with sure underlying medical circumstances are at elevated danger of an infection and should must take an antibiotic earlier than some dental procedures. Taking an antibiotic to forestall an an infection is named antibiotic prophylaxis [PDF – 1 Page].
Prior to now, antibiotic prophylaxis was generally prescribed to sufferers with prosthetic joints earlier than sure dental procedures to forestall joint infections. Nonetheless, knowledgeable pointers now not suggest 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 stop prosthetic joint infections and may 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. Speak 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, akin to 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 residence when my father had double knee replacements in 2023. His surgeon wished to prescribe dental prophylaxis regardless 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 staff have been persuaded to alter their antibiotic prescribing conduct. Sure, it was a whole lot of effort, but it surely was price it once I take into consideration the potential lives saved by lowering using pointless antibiotics.
Antibiotic stewardship for the dental setting
Antibiotic stewardship is crucial for affected person security and combating antimicrobial resistance. Stewardship goals to optimize the therapy of infections by making certain using antibiotics for the right prognosis, dose, length, and timing. Nonetheless, antibiotic stewardship in observe is greater than a scientific resolution. It’s a cohesive effort to interact the dental staff, medical professionals, and sufferers in a dedication to make use of antibiotics solely when needed primarily based on one of the best proof obtainable for decision-making.
As a part of the Affiliation for Dental Security (ADS) staff, I work to create and disseminate antibiotic stewardship content material. ADS was in a position to design and launch an Antibiotic Stewardship web site for dental prescribers, staff members, and sufferers utilizing funding supplied by the Facilities for Illness Management and Prevention (CDC).7 The web site gives curated sources for dentists together with toolkits, templates, chart audit instruments, and checklists, communication supplies akin to movies and podcasts, free persevering with schooling programs, and extra – all designed to advertise greatest practices in dental antibiotic prescribing to create a secure surroundings for sufferers.
How can the dental staff 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 staff might entry a one-page data sheet [PDF – 1 Page] that can be utilized when speaking with sufferers and a letter template [doc] to share this up to date data with orthopedic surgeons of their observe community.10 - Share success tales and greatest practices for optimizing antibiotic prescribing within the dental setting.
–ADS has issued a nationwide name for achievement tales, greatest 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 now we have an amazing 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. Modifications 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 observe 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 Danger 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 matter: Dental Antibiotic Stewardship Sources Bundle
Erinne Kennedy, DMD, MPH, MMSc, is an Assistant Professor and Assistant Dean for Curriculum and Built-in Studying at Kansas Metropolis College Faculty of Dental Drugs in Joplin, Missouri. Dr. Kennedy has intensive dental public well being experience and serves as a nationwide antibiotic stewardship spokesperson for the American Dental Affiliation and guide for the Affiliation for Dental Security (previously often known as OSAP).