Dental prophylaxis and alloplastic temporomandibular joint replacement (TMJR): time for a consensus?

Abstract

Searches of the literature and current guidelines have revealed inconsistent recommendations regarding dental optimisation prior to alloplastic temporomandibular joint replacement (TMJR). Furthermore, current literature suggests there is no consensus on antibiotic prophylaxis (AP) for dental procedures following TMJR. A 12-question survey was emailed to Professor Mercuri’s TMJ Internetwork Group (144 members) and The European Society of Temporomandibular Joint Surgeons (ESTMJS) (49 members), totalling 177 survey recipients, accounting for those who are members of both groups. Respondents were asked whether routine dental assessments were performed prior to TMJR, if they recommended AP following TMJR, the timeframes and types of procedures for which this was recommended, and the types of antibiotics prescribed. The survey had 50 respondents, as of 15 November 2024, giving an overall response rate of 28.2%, however, the question specific response rate ranged from 29 to 50 respondents. No consensus was reached regarding the types of AP recommended, with 54.2% (n = 26) of respondents offering no prophylaxis for dental treatment following TMJR. The majority of respondents who did provide prophylaxis preferred amoxicillin or co-amoxiclav (n = 25/37), and clindamycin for penicillin allergic patients (n = 13/46). The timeframe for which respondents felt that antibiotics should be offered for dental procedures post-TMJR varied from one month (n = 3/37) to lifelong (n = 6/37), with a modal response of two years (n = 9/35). This survey reflected the lack of consensus seen across available literature and highlights the need for unified guidance to ensure safe and consistent patient care for TMJR patients.