Dental Tribune U.S. Edition

DENTAL TRIBUNE | July 2011 Industry 15A procedures is required to prevent bacterial seeding of the joint in patients who have received total joint replacements. Previously, the three groups aligned and supported antibiotic prophylaxis for individuals who had had joints replaced within two years and those at higher risk due to medical conditions, however, a In 2007, when the American Heart Association changed the recommen- dations for antibiotic prophylaxis for routine dental care in patients with valvular heart disease, some dentists scoffed, others rejoiced. The policy change was the first of its kind since the organization began recommend- ing prophylaxis for routine dental procedures 50 years earlier. Considering the fact that an esti- mated 2 percent of the U.S. popula- tion carries the diagnosis of mitral valve prolapse, a relatively benign heart-valve disorder that had, until 2007, required administration of antibiotics in advance of any dental procedure (including routine clean- ing), this was indeed a noteworthy change. The use of antibiotics for the intended prevention of endocarditis in individuals at higher risk (those with valvular pathology) had far reaching effects on antibiotic resis- tance rates, the cost of medical and dental care, the number of emer- gency visits for allergic reactions to medications, even overall compli- ance with routine teeth cleaning visits. Some dentists chose to ignore the revised recommendations, respond- ing that the risks of bacterial endo- carditis were outweighed by the benefits of antimicrobial admin- istration, regardless of population effects. Other dentists were not aware that the recommendations had even been changed. Most have complied with the current recom- mendations and do not insist on antibiotic prophylaxis unless so indi- cated by evidence-based research. Health policy has, in many ways, changed the way that dentists and dental implant practitioners prac- tice. The influences of various medical societies will continue to have an impact for dental implant practitioners in the years to come given the expanding use of elec- tronic health records, the institu- tion of government-driven health reform programs and the paradigm shift from practitioner instinct to evidence-based decision making. These policy changes are intend- ed for the betterment of societal health care as a whole, however, they do not always reflect a con- sensus among medical and dental societies nor are they always readily applicable to the patient directly in front of us. A hotly contested topic between orthopedic surgeons, dentists and infectious disease experts involves the extent to which antibiotic pro- phylaxis prior to specific dental more recent publication from the American Association of Orthopae- dic Surgeons (AAOS), put forth in February 2009 and revised in June 2010, states that all patients with total joint replacements should be given antibiotic prophylaxis for spe- cific medical and dental procedures for the rest of their lives. The impetus, consequences and AD controversy of this change are still being widely debated. In response to the AAOS statement, the American Academy of Oral Medicine issued a pointed rebuttal debunking the reasoning behind the AAOS state- ment paper and reminded practi- tioners to make their own clini- Health policy and the dental implant practitioner By Arun Garg, DMD g DT page 16A