A recent study found that dentists and orthopedic surgeons significantly disagree on prescribing antibiotic prophylaxis before dental procedures for patients with joint replacements, with surgeons more likely to recommend preventive antibiotics than dentists, despite current ADA guidelines showing no protective benefit from such antibiotics.
- Major disagreement: Only 12% to 27% of dentists found antibiotic prophylaxis appropriate in various cases, compared to 44% to 60% of orthopedic surgeons.
- Current guidelines: The ADA states there is no proven connection between dental procedures and prosthetic joint infections and no protective benefit from preventative antibiotics.
- Risk-based approach: AAOS guidelines recommend antibiotic prophylaxis only for highest-risk patients undergoing invasive dental procedures.
- Key takeaway: Better communication and education between dental and orthopedic teams is essential to align treatment decisions with current evidence-based guidelines.
When it comes to patients with total knee and total hip arthroplasty, dentists appear to not find it appropriate to prescribe antibiotic prophylaxis before dental procedures, according to a study published recently in BMC Oral Health.
However, orthopedic surgeons may be more inclined to administer preventive antibiotics, the authors wrote.
“It is of great importance that both orthopaedic surgeons and dentists are informed about the current guidelines on this subject,” wrote the authors, led by Kübra Karaçam of Afyonkarahisar Health Sciences University in Turkey (BMC Oral Health, September 3, 2026, Vol. 26, 1702).
The ADA's most recent guidelines state that current research shows no connection between dental procedures and prosthetic joint infections and that there’s no protective benefit for administering preventive antibiotics before dental procedures.
Later, ADA and American Association of Orthopaedic Surgeons (AAOS) members developed appropriate use criteria to define clinical scenarios in which patients could benefit from prophylaxis. Current AAOS guideline criteria call for antibiotic prophylaxis to be administered for the highest-risk patients undergoing invasive procedures.
To investigate the attitudes of dentists and orthopedists toward preventive antibiotics, 406 respondents completed a questionnaire gauging their tendencies to administer antibiotic prophylaxis in various clinical situations. Of the respondents, 104 were dental practitioners, 146 were dental specialists, and 210 were orthopedic surgeons.
Dentists and orthopedic surgeons aren’t on the same page
For a case in which a healthy woman developed a prosthetic joint infection and had secondary surgery almost a year after a total knee replacement, nearly 12% of dentists reported that preventive antibiotics were appropriate. Meanwhile, almost 60% of orthopedic surgeons found it appropriate, the authors wrote.
In another example, a 68-year-old woman with diabetes who had a total hip replacement due to hip necrosis caused by immunosuppressive drugs after a liver transplant needed treatment for dental erosion. In this case, about 19% of dentists reported that it would be appropriate to administer antibiotic prophylaxis. However, nearly 44% of orthopedic surgeons reported finding it appropriate, they wrote.
In another instance, a 72-year-old healthy man had total knee arthroplasty eight months ago. The patient requested a tooth extraction after seven days of antibiotics for an infected molar. For this scenario, about 27% of dentists and approximately 54% of orthopedic surgeons reported that administering antibiotic prophylaxis would be appropriate, the authors wrote.
Some study shortcomings
Nonetheless, the study had limitations. Including a greater range of case scenarios and more dentists and surgeons may have provided better results about clinicians’ tendencies, they wrote.
“Orthopaedic surgeons were more inclined to administer antibiotic prophylaxis than dentists,” Karaçam and team wrote.
