[Antibiotic prophylaxis for patients with joint prostheses undergoing dental treatment--a topic for discussion]

In accordance with international guidelines, the German Society for Cardiology and the Paul Ehrlich Society for Chemotherapy recently adapted their recommendations for antibiotic prophylaxis of infectious endocarditis. The new version reflected the statistically lower risk for such infections as compared to former considerations and reduced the group of patients who would benefit from the prophylaxis. That paper as well as an increasing number of statements of orthopaedic/traumatologic or dental societies stimulated our contribution on the prevention of prosthesis infections after dental care. With this article we intend to stimulate a position paper of the German Society for Orthopaedics and Traumatology.

For our study we screened the international literature on the association between bacteremia and dental treatment, bacteremia and prosthesis infections as well as on the availability and risks of antibiotic prophylaxis for prosthesis infections. In addition, we included data on the responsible microorganisms and the importance of biofilms both in the oral cavity and on the infected prosthesis.

Generally, the risk of prosthesis infections after bacteremia is lower than that of endocarditis. Also, the range of involved microorganisms only partially overlaps in both diseases. Of note, bacteremia regularly occurs due to normal dental hygiene measures or even after chewing. Because of this high background risk and because of the extended latency period between dental care and symptomatic prosthesis infections, the causality of professional dental measures for prosthesis infections has never conclusively been demonstrated, e.g., by employing molecular methods. However, the association remains plausible and the consequences for such patients are severe.

We suggest an oral prophylaxis with an aminopenicillin plus beta-lactamase inhibitor or clindamycin shortly before and 4 hours after dental care depending on the tissue invasiveness of the dental measures and the personal risk profile of the patient (prosthesis recently implanted, history of prosthesis infection, natural or iatrogenic conditions severely affecting the immune status).