Why is antibiotic prophylaxis before dental procedures no longer routinely recommended for patients with total joint replacements?

The 2012 evidence-based clinical practice guideline from the American Academy of Orthopedic Surgeons (AAOS) and ADA concluded that the evidence was insufficient to recommend antibiotic prophylaxis for all patients with prosthetic joint implants prior to dental procedures. Subsequent reviews and the 2022 ADA position statement further affirm that for most patients, antibiotic prophylaxis before dental procedures is not necessary because bacteremia from dental procedures is brief and low-grade, similar to that from daily activities like toothbrushing. The decision should be individualized based on patient-specific risk factors in consultation with the orthopedic surgeon.