New CDA Position Statement on Dental Patients with Total Joint Replacement


A newly revised CDA Position Statement emphasizes that routine antibiotic prophylaxis is not indicated for dental patients with total joint replacement.

The CDA statement differs slightly from a joint 2012 American Dental Association (ADA)/American Academy of Orthopedic Surgeons (AAOS) clinical practice guideline, which advises dentists to “consider discontinuing” the practise of routinely prescribing prophylactic antibiotics for such patients.

The CDA statement, adopted in June 2013, was based on a review of the clinical evidence by CDA’s Committee on Clinical and Scientific Affairs (CCSA). This evidence included a thorough systematic review of the literature conducted by the ADA and AAOS in 2011.

The CCSA determined that the best available evidence indicates that routine dental procedures do not cause prosthetic joint infections and therefore that antibiotics provided before oral care are not necessary to prevent infections of orthopedic implants.

“CDA believes that Canadian dentists require clarity in this area and therefore asked the CCSA to review the work of a variety of experts and groups to further understand the evidence and inform our position,” says Dr. Benoit Soucy, CDA director of clinical affairs.

“CDA’s new statement remains closely aligned with our previous statement on the issue, one that is essentially unchanged since 2003,” he notes. “We were concerned that the wording of the 2012 ADA/AAOS guidance could prove confusing and, in fact, the recent publications bring the CDA and ADA/AAOS recommendations closer in alignment.”

Dr. Soucy adds that decisions with regard to antibiotics for patients are ultimately the decision of dentists and should be made within a context of open communication and informed consent between patient and clinicians.

Related Resources:

  1. 2013 CDA Position on  Dental Patients with Total Joint Replacement
  2. Q&As on the 2013 CDA Position on Dental Patients with Total Joint Replacement
  3. ADA/AAOS Antibiotic Prophylaxis Guideline for Dental Patients with Orthopedic Implants. J Can Dent Assoc 2013;79:d28
  4. 2012 American Dental Association (ADA) / American Academy of Orthopedic Surgeons (AAOS) clinical practice guideline
  5. ADA/AAOS Shared Decision Making Tool
  6. Morris AM, Howie S. Recommendations for Antibiotics in Patients with Joint Prosthesis Are Irresponsible and Indefensible. J Can Dent Assoc. 2009;75(7):513-5.
  7. Napeñas JJ, Lockhart PB, Epstein JB. Comment on the 2009 American Academy of Orthopaedic Surgeons’ Information Statement on Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements. J Can Dent Assoc. 2009;75(6):447-9.