Professional Insurance Programs

PPP Risk Management: ADA Council on Scientific Affairs…

The ADA Council on Scientific Affairs has released an updated guideline. Please reference the letter below.

Dear Doctor,

This month, the ADA Council on Scientific Affairs (CSA) published an update to the 2012 guideline, Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. An expert panel assembled by the CSA developed a report which the CSA approved in July 2014. The guideline, based on a systematic review of the evidence, appears in the January edition of the Journal of the American Dental Association (JADA). Below please find several links to the new guideline and related information.

The 2012 guideline recommended that dentists might consider discontinuing┬áthe practice of prescribing antibiotic premedication for orthopedic implant patients. The 2014 guideline states that prophylactic antibiotics before dental procedures are not recommended for patients with prosthetic joint implants. The CSA has also published a “chairside guide” to assist with implementation of the new guideline. As in the past, the decision to prescribe or not prescribe should be made after considering the evidence, your experience and the patient’s needs/preferences. Please take time to review the information found at the URLs below for more detail.

You may encounter physicians who recommend continued premedication. It is still appropriate and prudent to discuss the benefits and risks of the dental procedures and antibiotic premedication in this situation, since the patient is under the care of both practitioners. Communication will be critical to reach a consensus with the physician. In some cases, an impasse will occur, resulting in continued disagreement regarding the proper course of action for the patient. In such cases, you may wish to suggest to the patient and/or physician prescribe the antibiotic premedication. Other options include a recommendation that the patient receive a second physician opinion, or you may wish to withdraw from the dentist-patient relationship in some cases. If uncertain about the applicability of the new guideline to a patient’s specific medical condition(s), consult the patient’s physician and request a consultation and written report.

Sincerely,

CNA-PPP Risk Management