Persistent Dentist Prescribing of Prophylactic Antibiotics for Prosthetic Joint Infection

Objectives: In 2015, the Journal of the American Dental Association published an evidence-based practice guideline on the use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints. This guideline builds upon the evidence-based guidelines published by the American Academy of Orthopedic Surgeons in 2012. This study assesses the extent to which dental practitioners are following these guidelines.
Methods: E-mail addresses were obtained for all active New Jersey dentists from Department of Consumer Affairs web-site. After IRB approval, Qualtrics survey was administered via e-mail. The survey contained questions about their prophylactic prosthetic joint infection (PJI) practices and why they follow or don’t follow the guidelines. Three reminder e-mails were sent to non-respondents. Descriptive and comparative statistics (Chi-Square/Fisher’s Exact Test) were calculated using IBM SPSS Statistics 25.
Results: 5273 e-mail address were obtained. Of the 4940 successfully sent e-mails, 592 (12.0%) dentists responded. 31.2% of dentists reported not generally prescribing antibiotics for patients with total joint replacement. 44.4% generally prescribe antibiotics within 2 years of joint replacement and 24.4% continue to prescribe 2 years after replacement. 82.4% report normally following advice of an orthopedic surgeon even if it contradicts the most recent guidelines. The most common cited reasons for following the orthopedic surgeon’s advice was legal risk management (65.4%), error on the safe side (57.2%), patient expects me to follow the advice of the surgeon (51.4%) and not wanting to contradict the surgeon (27.9%). Characteristics of dentists (graduation year categories, practice type, faculty or hospital appointment or gender) were not associated with antibiotics prescribing behavior.

Conclusions: More than two-thirds of responding dentists are still routinely prescribing prophylactic antibiotics for PJI, a practice not consistent with the most recent guidelines. Additional studies which provide solid evidence about the risk of PJI and effectiveness of prophylactic antibiotics could further orthopedic surgeon recommendation and dentist practices.