People with replacement joints have long been told to take antibiotics before having even routine dental treatment. But that advice isn’t as widely supported as it once was. Current guidelines from the American Academy of Orthopaedic Surgeons say that orthopedists “might consider discontinuing” routine prescription of antibiotics before dental procedures. The wording may be judicious, but it’s unhelpful to someone trying to reach a thoughtful decision.
If the weight of evidence points to discontinuing routine prophylaxis, why do many surgeons and dentists continue to recommend it?
One factor is that old habits die hard. The professional organizations — AHA, ADA, AAOS — can issue guidelines, but they cannot tell their members what to do. Robert Quinn, head of orthopedic surgery at the University of Texas Health Science Center in San Antonio, is moderator of an AAOS panel that’s reviewing the 2015 ADA guidelines with a view to revising their own guidelines. He says his group’s conclusions, set to appear at the end of this year, are unlikely to be very different from what the ADA has suggested, but he acknowledges that “a lot of people who have been in practice for a while” tend to be skeptical of change. “There is a big push for evidence-based decisions,” he says, “but there is also pushback [based on long-standing practice]. We need to navigate thoughtfully.”