Keep your Knowledge Current: Antibiotic Prophylaxis
by Bethany Benoit-Kelly on 9/26/2018 1:47 PM
"What is the College’s position on antibiotic prophylaxis for dental patients with total joint replacements?"
"What should I do if my patient says her orthopedic surgeon told her she should always take antibiotics before a dental procedure?"
These are the sorts of questions we get from registrants looking for guidance when it comes to antibiotic prescribing.
The fact is, antibiotic prophylaxis is not required for dental patients with prosthetic joints. Dentistry has long taken this approach, which was confirmed by the 2016 consensus statement* from the Canadian Orthopaedic Association, the Canadian Dental Association and the Association of Medical Microbiology and Infectious Disease.
While this consensus statement represents the expected standard of care, it is a guidance document and is not meant to be prescriptive. Depending on the procedure and/or the patient’s medical status, prophylactic antibiotics may very well be required, but not specifically because of the presence of a prosthetic joint.
At the end of the day, it’s up to the treating dentist to use their own clinical expertise and judgment and to take into account the patient’s history, including any existing condition that might affect treatment outcomes. It is always up to the dentist to make the final recommendation as to the need for pre-treatment antibiotics when dental services are being provided.
Staying Current
As the regulator, the College intentionally does not always define or quantify specific aspects of patient care at the patient/dentist interface. This allows the practitioner latitude to provide care that is specific to the patient and in their best interest.
It is, however, the ethical duty of all registrants to "commit to the highest level of professionalism by maintaining current knowledge and competency" (Principle 4, CDSBC Code of Ethics).
Beyond this ethical requirement, staying current in our knowledge is also an expectation from our patients – it’s part of what makes us professionals.
Back to the opening question about the patient asking for antibiotics on the advice of her surgeons: the best approach here would be to explain to the patient what you see as best practices. If she insists on having the medication prescribed, it would be prudent to contact the surgeon in question and have a discussion with them about the case and your concerns before any treatment is provided. Colleague -to-colleague discussion may well be the best way to resolve the issue and is in the patient’s best interest.