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

Correct answer: B. There is insufficient scientific evidence that it prevents prosthetic joint infection

• A. Incorrect. Transient bacteraemia occurs after dental procedures and also from routine daily activities such as toothbrushing and chewing.
• B. Correct. The ADA and AAOS concluded that the evidence does not support a link between dental procedures and prosthetic joint infection, and that prophylaxis risks (resistance, adverse reactions, C. difficile) outweigh unproven benefit.
• C. Incorrect. Prosthetic joints certainly can become infected — but predominantly by skin flora at the time of surgery or by haematogenous spread from non-oral sources.
• D. Incorrect. Antibiotics are effective against the relevant organisms; the issue is whether prophylaxis in this context prevents anything.