# Appropriateness of Antibiotic Prescriptions Written for Dental Prophylaxis Within a Regional Veterans Affairs Healthcare System Based on American Dental Association and American Academy of Orthopaedic Surgeons Guidance

## TL;DR

This study found that most antibiotic prescriptions for dental prophylaxis in a VA healthcare system were inappropriate, especially for patients with orthopedic implants.

## Contribution

The study provides new insights into antibiotic overuse for dental prophylaxis in a VA system, highlighting provider-specific and guideline-related discrepancies.

## Key findings

- 67% of all dental prophylaxis antibiotic prescriptions were not indicated according to ADA and AAOS guidelines.
- Prescriptions for orthopedic conditions were mostly deemed inappropriate under both 2017 and 2024 AAOS guidelines.
- Dentists were more likely to write appropriate prescriptions compared to primary care providers or orthopedic specialists.

## Abstract

We determined the prevalence of inappropriate dental prophylaxis antibiotic prescriptions written by providers within a Veterans Integrated Service Network based on American Dental Association (ADA) and American Academy of Orthopaedic Surgeons (AAOS) guidance.

We conducted a retrospective cohort study of antibiotic prescriptions written for dental prophylaxis from 1 May 2023 through 30 April 2024. Prescriptions were defined as indicated if the patient met ADA guidance criteria. A subset of prescriptions written for patients with orthopedic implants was assessed for appropriateness when applying the 2017 and 2024 AAOS guidelines.

Of 622 prescriptions, 53%, 37%, and 10% were written due to underlying orthopedic, cardiac, and other conditions, respectively. Dentists prescribed 51% of prescriptions, followed by primary care providers (35%) and orthopedic specialists (9%). Overall, 67% prescriptions were not indicated. When considering indication, agent, and dose, 72% of prescriptions were inappropriate. Prescriptions written due to cardiac conditions were more likely to be indicated than prescriptions written due to orthopedic conditions (P < .0001). Prescriptions written by dentists were more likely to be indicated than prescriptions written by primary care providers (P = .004) or orthopedic specialists (P < .0001). When applying 2017 AAOS guidelines to prescriptions written due to orthopedic conditions (n = 330), 0%, 8%, and 92% were considered “appropriate,” “maybe appropriate,” and “rarely appropriate,” respectively. When applying 2024 AAOS guidelines, 100% were not indicated.

Our results suggest substantial antibiotic overuse and lack of adherence with ADA and AAOS recommendations, particularly among patients with orthopedic implants. These results highlight the need for multifaceted stewardship interventions targeting not only dentists, but all types of providers.

A retrospective cohort study of antibiotic prescribing by all provider types for dental prophylaxis within a regional Veterans Affairs system found substantial lack of adherence with ADA and AAOS recommendations, particularly among patients with orthopedic implants.