Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

From Trisha's Desk Trisha E. O’Hehir, RDH, BS Hygienetown Editorial Director

Start Discussion More by this author (282)

The Standard of Premedication

Trisha E. O'Hehir, RDH, BS
Editorial Director,
Hygienetown Magazine




Every day in dental practices around the world, dentists and hygienists work together to diagnose and plan effective treatment for their patients. To bolster this natural collaboration, feature stories, content from the message boards of Hygienetown.com and Perio Reports research summaries are presented in every issue of Dentaltown Magazine. The goal of this section is to present topics that will create discussions between dentists and hygienists to ultimately improve dental hygiene outcomes.		 On August 31, 2009, a discussion on the Dentaltown.com message boards which also jumped over to Hygienetown.com, alerted Townies to new premedication changes for patients with total joint replacements. These new regulations were announced in an “Information Statement” by the American Academy of Orthopedic Surgeons (AAOS) February 2009, with little to no fanfare, which in turn went mostly unnoticed by clinicians. The change is significant and will change practice policy, especially if you ever find yourself in court being sued by a patient who suffered from an infection in his or her artificial joint within weeks or months of a visit to your dental practice.

Here’s what was printed in the AAOS information statement: “Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia. This is particularly important for those patients with one or more of the following risk factors.” The list of potential risk factors followed with this topping the list: “All patients with prosthetic joint replacement.”

This replaces the previous standard of premedication for the first two years following a joint replacement and none thereafter. Now, these patients need premedication before all dental procedures that might elicit bacteremia, as that’s the general definition of “invasive.” That means telling all those patients that now they need premedication! As Townie “temple27” put it, “I just hope I don’t have any patients with joint replacements on my schedule today that I told didn’t need to take antibiotics.”

The AAOS claims that antibiotic premedication for all patients with joint replacements for the life of the artificial joint is not a “standard,” but several Townies pointed out in the Dentaltown.com message board that going to court without having provided premedication would not be looked on favorably by a jury. The AAOS dances around the clinical implications of their new recommendation by saying, “This statement provides recommendations to supplement practitioners in their clinical judgment regarding antibiotic prophylaxis for patients with a joint prosthesis. It is not intended as the standard of care nor as a substitute for clinical judgment as it is impossible to make recommendations for all conceivable clinical situations in which bacteremias may occur. The treating clinician is ultimately responsible for making treatment recommendations for his/her patients based on the clinician’s professional judgment. Any perceived potential benefit of antibiotic prophylaxis must be weighed against the known risks of antibiotic toxicity, allergy, and development, selection and transmission of microbial resistance. Practitioners must exercise their own clinical judgment in determining whether or not antibiotic prophylaxis is appropriate.”

Townie “emcgee” called the AAOS to ask why the change was made. Here’s what he said he was told: “The reason that the two-year limit was removed was because they could find no literature to support why the two year limit was placed in the first place. None of the current committee members were on the committee in 2003. They felt that the risk from antibiotics two-to-three times a year was far lower than the risk of a reinfected joint. They did not list specific high-risk procedures because they did not feel comfortable dictating risk to other specialties.”

Which poses the greatest risk, joint infection due to dental procedures or anaphylactic reactions to the antibiotic? This question remains unanswered.

Inside This Section
96 Perio Reports
100 Message Board: Cancer, Chemo and Mouth Sores
Dentaltown Magazine
September 2025
Dentaltown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
Who or what do you turn to for most financial advice regarding your practice?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450