Chemoprophylaxis of dental patients with prosthetic joints: a simulation model.

A computer simulation model was created to assess the risks and effects of no prophylaxis, oral penicillin, and oral cephalexin regimens for dental patients at risk for late prosthetic joint infection (LPJI). Given the assumptions made, this analysis suggests that there is a very small risk of LPJI (29-68 cases per 10(6) dental visits), which is outweighed by a greater risk of death from a fatal antibiotic reaction. Thus, routine predental antibiotic prophylaxis for all dental patients with prosthetic joints may lead to higher mortality. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in "high risk" patients.