Appropriate Use Criteria

 Scope

The scope of this AUC is intended to cover the majority of patients, who are “average” or “lower” risk patients as there is no data to guide decisions on the small population of higher risk patients such as patients with revision implants, mega-prostheses, poor soft tissue envelopes, prior prosthetic joint infection.

With this AUC, we have attempted to define clinical situations in which antibiotic prophylaxis prior to dental procedures in average risk patients could reduce a theoretical risk of post-surgical prosthetic joint infection.

When an orthopedic surgeon discusses the role of antibiotic prophylaxis with a patient before a dental procedure, it is also important to encourage routine, proper dental care and hygiene as an equal or more important infection prevention measure. Appropriate dental care is always recommended. 

It is assumed that antibiotics, if prescribed, will take into account any patient allergies or drug – drug interactions; This is what is meant by “patient-appropriate” antibiotics in the tool.

Planned Dental Procedures

• The chance of oral bacteremia being related to joint infections is extremely low, with no evidence for an association.
• Oral bacteremia frequently occurs secondary to activities of daily living such as tooth brushing and eating.
• Virtually all dental office procedures have the potential to create bacteremia.

Definitions:

1. Level of Invasiveness

Non-Invasive

• Dental examination without probing dental radiograph or cone beam CT imaging, denture adjustment procedures, clear orthodontic aligner (invisible braces) adjustment procedures, occlusal guard or bite splint adjustment
• Oral hygiene procedures including dental cleaning, dental prophylaxis using a rubber cup and handpiece [without scaling] or periodontal probing (without SRP)
• Orthodontic procedures including banding or debanding orthodontic fixes or removable appliances, archwire adjustment, orthodontic mini-implant removal, orthodontic separate placement
• Other non-invasive procedures including suture removal, anesthetic injection, crown and bridge placement, dental restorative procedures, rubber dam clamp or matrix band wedge between teeth, impression taking, endodontic treatment (root canal therapy).

Invasive

• Scaling and/or root planing (SRP) with manual (hand instruments) or ultrasonic scaler
• Dental Extractions including single, multiple, impacted third molar
• Oral Surgery (including dental implant surgery, periodontal surgery, cleft palate surgery, piezoelectric surgery, osteosynthesis plate removal)
• Treatment of Active Dental Infection

2. Immunocompromised 

For a comprehensive list of conditions that are defined by CDC guidelines as severely immunocompromised, please see the following citation linked here. 

Disclaimer

Volunteer physicians and dentists from multiple medical and dental specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment.