As of the fall of 2016,there was a release of a consensus statement from the Canadian Orthopedic Association(COA) and the Canadian Dental Association(CDA) regarding the practice of antibiotic use before dental procedures.
This statement was the second time there has been a change since 2003.
There has been a debate for years as to the risk of having an infection develop to an artificial hip or knee after dental procedures. It is a fact that dental treatment can irritate the tissues (i.e. injections,scaling,placing deep fillings , etc.) causing bacteria from the mouth to enter the bloodstream. This is usually not of any significance, as this process occurs anyway through daily function of eating when irritation of the gums occurs , or active gum disease. It has been theorized that these bacteria can attach to the joints however, causing a seeding of the joint,causing infection, that can potentially lead to a joint failure. The reason for this is that the infection is difficult to get under control, requiring an aggressive plan of intravenous and oral antibiotics at a high dose and over a long period. The incidence of infection is low,as indicated from the Canadian Association of Hospital Dentists:
“Hip and knee replacements are some of the most common surgical procedures in Canada, with approximately 1-2.5% of such replacements being complicated by infection. The overwhelming majority of these prosthetic joint infections (PJI) occur in the first year following surgery, and are predominantly due to organisms usually found on the skin. The best available evidence suggests that the majority of PJI are acquired at the time of surgery. Although it is possible that infection can occur due to bacteremia from other sites unrelated to the index surgical procedure—these do occur—the importance of these as a cause of PJI is low”.
There are documented cases of infections from bacteria that originate from the mouth,albeit rare. Again the debate for antibiotic coverage before dental treatment is fuelled because its impossible to tell if the seeding was from the actual dental treatment(which is of short duration) or from daily continuous exposure of the blood from oral bacteria.
The debate is further complicated by the fact some people have developed allergies to multiple doses of antibiotics ,and in some cases have had anaphylactic reactions,causing in worst case, death.
The new consensus in 2016 states that routine antibiotic prophylaxis is no longer indicated.This office had always followed the recommendation that was in effect at the time.
However, at this office we have had the unfortunate situation where a patient,who had a knee replacement in December 2016 and who had a routine filling placed in this office in March, had a subsequent infection develop to his joint and the culture results confirmed the bacteria were oral.
Our hope of speedy recovery to our good, long term patient is amplified by the fact Dr. Tessier himself has had both knee replacements. He has also experienced infection complications after surgery albeit skin infection.
After discussing the case with his orthopedic surgeon, we agreed that a compromise to the guideline be used( and this is reflective of his colleagues in Kingston):
All patients at this office are to be brought aware of the complexity with the guideline and be issued antibiotics FOR ONE YEAR after the date of placement of the joint. As has been observed, most infections are soon after placement. A year will give protection while the joint is healing.