With an aging population and with the number of patients with large prosthetic joints increasing, the recommendation of antibiotic use in this specific population has generated significant discussion. Dentists often treat patients with large prosthetic joints; however, little is known regarding the prescribing practices of dental providers. This cross-sectional study carried out in the State of Iowa, United States, evaluated whether dentists were familiar, followed, and were satisfied with the 2015 American Dental Association Clinical Guidelines and the 2016 American Academy of Orthopaedic Surgeons Appropriate Use Criteria (AUC), and whether dentists responses were associated with demographic and provider characteristics. Dentists’ concerns about antibiotic resistance, medical legal aspects, and adverse effects related to using antibiotic prophylaxis were also examined.
Of the 1521 surveys that were sent by mail, a total of 635 were returned, for a response rate of 41.7%. Our results confirm that dental practitioners were very concerned about antibiotic resistance (43.9%) compared to 5.23% who were not at all concerned. In addition, female subjects were significantly more likely to be very concerned about antibiotic resistance than were male subjects (50.9% vs 41.4%; p=0.0376). Moreover, subjects that practiced in urban areas were more likely to be very concerned about antibiotic resistance that those practicing in rural areas (47.9%vs 37.5%; p=0.0157). We also observed that for a healthy patient, 28.9% of dentists would never recommend antibiotics. On the other hand, 44.9% of the respondents would recommend antibiotic premedication within the first 2 years since prosthetic joint replacement, 14.1% would recommend it within the first year, and 6.9% would recommend it for life. Dentists were aware of the lack of effectiveness of antibiotic prophylaxis in preventing prosthetic joint infection. However, premedication recommendations by physicians and patient preferences influenced dentist’s prescribing practices. Overall, dentists’ recommendations for the use of antibiotic for patients with prosthetic joints undergoing dental procedures varied depending on the health status of the patient, the dental procedure to be performed, the time since joint surgery, physician’s recommendations and patients preferences.