While the guidelines have changed regarding many previous reasons for premedication, an expert panel concluded that “prophylactic therapy is still advised in patients at high risk of hematogenous total joint infection.” The panel consisted of dentists, orthopedic surgeons, and infectious disease specialists who reviewed the scientific evidence of need for this group. Bacteremia can be created from dental or medical surgery and infections of the skin, oral cavity, respiratory systems, or urinary tract. Since the 1980s, joint infections have been reduced due to prophylactic procedures applied to 450,000 arthroplasties each year. The panel recommended that pa-tients planning joint re-placement surgery be seen by their dentist to rule out any potential threat and to ensure good oral health before surgery. Postoperatively, joint replacement patients should work to maintain good oral health to reduce the chance of bacte-remia and oral infection. In general, patients at high risk of oral infection and possible bacteremia include high-risk patients within the first 2 years after joint replacement surgery, patients who have had previous joint infections, immunocompromised and immunosuppressed patients, patients with comorbidities, and patients with acute orofacial infections. The panel also ruled that treatment should be based on the providers’ best judgment and appropriate prevention therapy.
(Source: The Oral Care Report, 2008, Volume 18, Number 1)
