Abstract
Introduction: An extensive review of the literature has found no evidence supporting the routine use of antibiotic prophylaxis in patients with prosthetic joints undergoing dental treatment. A working party of the British Society for Antimicrobial Chemotherapy have stated that “patients with prosthetic joint implants (including total hip replacement) do not require antibiotic prophylaxis for dental treatment” and that “it is unacceptable to expose patients to the adverse effects of antibiotics when there is no evidence that such prophylaxis is of any benefit”.
Method: A postal questionnaire containing both open and closed questions regarding prescribing habits and protocols with respect to antibiotic prophylaxis in patients with prosthetic joints undergoing dental treatment was sent to all General Dental Practitioners and all Consultant Surgeons in Northern Ireland. Response rates of 72% and 97.5% were obtained from the two groups.
Results: The majority of Dentists (82–96%) routinely prescribe antibiotic cover in patients with structural heart defects but not in those who have had a joint replacement (24%) with Penicillin being the most frequently used antibiotic. 43% of Dentists have however, been asked by an Orthopaedic Surgeon to give cover with 216 of these 242 having given it. Responding Orthopaedic Surgeons indicated that the majority (63%) prefer their patients to have cover during dental extractions. A Cephalosporin is the most commonly suggested antibiotic(25%). Only one of the Surgeons given advice to his patients to ask for antibiotic cover during dental procedures.
Conclusion: We conclude that current practice, particularly amongst Orthopaedic Surgeons with regard to antibiotic prophylaxis in patients undergoing dental extraction following joint replacement does not adhere to national recommendations and that dissemination of the guidelines is essential.
The abstracts were prepared by Emer Agnew, Secretary to the IOA. Correspondence should be addressed to him at Irish Orthopaedic Association Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
