In my fourth year of the UBC dental hygiene program, I am responsible for advanced medically complex clients. Recently, I met a client who came in for dental hygiene treatment, with a chief concern that his 27-molar felt ‘loose’. Upon the medical history charting and initial dental exam, the client presented with a few systemic medical conditions, inclusive of a recent knee-joint replacement. According to the College of Dental Hygienists of British Columbia, the recommendations for the treatment of clients with orthopaedic joint replacements, in conjunction with the Canadian Orthopaedic Association, the Canadian Dental Association, and the Association of Medical Microbiology and Infections Disease Canada are:1
- Patients should not be exposed to the adverse effects of antibiotics when there is no evidence that such prophylaxis is of any benefit.
- Routine antibiotic prophylaxis is not indicated for dental patients with total joint replacements, nor for patients with orthopedic pins, plates and screws.
- Patients should be in optimal oral health prior to having total joint replacement and should maintain good oral hygiene and oral health following surgery. Orofacial infections in all patients, including those with total joint prostheses, should be treated to eliminate the source of infection and prevent its spread.
In addition, it is important to consider the client’s medical status when considering antibiotic prophylaxis.1 After initial assessment, with the client’s permission, I contacted the client’s medical team, including the client’s orthopaedic surgeon.2 Upon contact and communication with the client’s health care team, neither health care professional indicated a need for antibiotic prophylaxis prior to dental treatments. However, with the guidance of my professors, antibiotic prophylaxis was recommended (and prescribed by the dentist on the floor), especially since the client had his knee surgery six months ago, and not had a dental visit in the last three years.3 With this, I was able to inform the client of the importance of antibiotic prophylaxis in regards to his recent knee-joint replacement and other systemic conditions.2
At the second appointment, the client took the antibiotic prescription as indicated and periodontal debridement was provided.2 Shortly after the dental hygiene appointment, and since the client was already on antibiotic prophylaxis, the client was scheduled for a 27-tooth extraction as well.
Halfway between the second and last (upcoming appointment), I decided to call my client for a follow up on the extraction. At this moment, the client divulged that he had taken the rest of his antibiotic prescription which was meant for prophylaxis prior to the dental hygiene appointments. Immediately, I asked the client all questions possible as to why he would inappropriately take his antibiotics, and client indicated that his wife told him to do so. The misuse of antibiotics risks the development of antibiotic resistance.3
Nonetheless, the last appointment with the client was dedicated to comprehensive education as well as understanding of the client’s perception of his medical conditions, his ideology on medications and prevention, and thoroughly explaining each medical condition in relation to dental hygiene practice to the client.2 Educating the client on how antibiotic prophylaxis is recommended for the prevention of joint failure by preventing oral bacteria transferring to the joint surgical site via the bloodstream, was effective as the client understood the severity of his systemic conditions.
References:
- College of Dental Hygienists of British Columbia. Treatment of clients with an orthopaedic joint replacement [Online]. 2010 [updated 2017 Jan; cited 2019 Apr 4]. Available from: http://www.cdhbc.com/Practice-Resources/Interpretation-Guidelines/Antibiotic-Premedication-(Orthopaedic-Joint-Replac.aspx
- Canadian Dental Hygiene Association. Entry-to-practice competencies and standards for Canadian dental hygienists [Online]. 2010 Jan [cited 2019 Apr 1]. Available from: https://www.cdha.ca/pdfs/Competencies_and_Standards.pdf
- Antibioticwise.ca. What is antibiotic resistance [Online]. 2019 [cited 2019 Apr 4]. Available from: https://antibioticwise.ca/what-is-antibiotic-resistance/