Does antibiotic prophylaxis for dental treatment prevent periprosthetic infections?

The German Society for Arthroplasty (AE) recommends a single dose of 2,000 mg amoxicillin as an antibiotic prophylaxis to prevent periprosthetic joint infections (PJI) in patients with total hip or knee arthroplasty (THA, TKA) who undergo invasive dental procedures (DP). We searched for evidence to support this recommendation.

We conducted a Medline query and made additional searches based on the literature found in the Medline database. We looked for relevant recommendations on antibiotic prophylaxis (AP) in other countries, as well as for standardized reviews and other studies published after the last reviews on the question of antibiotic prophylaxis for joint implant recipients in connection with dental treatment.

In twelve countries, no current guideline recommends general antibiotic prophylaxis for dental procedures, seven guidelines suggest that antibiotic prophylaxis should be considered in patients with risk factors, and five guidelines recommend that antibiotic prophylaxis be considered in conjunction with specific dental procedures that have an increased risk. Three reviews (2012, 2017 and 2020) mostly comprised of low-quality studies, all agreed that there is no direct evidence to indicate AP prior to dental procedures in patients with total joint arthroplasty (TJA). Six new retrospective studies from four countries on three continents, which included a total of more than 200,000 patients with TJA, confirmed the results of earlier studies: PJIs are rare and not significantly associated with DPs, and AP does not significantly reduce the (already low) risk. This applies not only to primary but also to revision TKA. Furthermore, a recent study comprising 61,124 patients with TJA or cardiac conditions who received AP for DP found that 62 (0.1%) experienced serious adverse drug events.

Even though most studies were conducted retrospectively and are based on insurance data and not on the analysis of individual medical records, it should be noted that there is still no robust evidence showing that dental procedures increase the risk of PJI, nor that AP has a risk-reducing effect both for primary THA and TKA as well as for revision TKA. Therefore, it is suggested that the AE should revise its recommendation, announced in 2022, in order to avoid the risks of unnecessary AP.