The American Dental Association does not recommend the use of prophylactic antibiotics in patients with prosthetic joints who are undergoing dental procedures, as clinical evidence fails to demonstrate an association between dental procedures and prosthetic joint infection (PJI) or any effectiveness for antibiotic prophylaxis. This recommendation is due to case-control studies that did not show any association between dental procedures and the risk of PJI. One of four studies, however, did support antibiotic prophylaxis. Although only a few studies exist, the panel believes further studies would not result in changes to the conclusion made. Furthermore, this evidence can be extrapolated to all joints due to the physiological characteristics of the tissues involved. Other considerations for this recommendation include the risk of antibiotic resistance, anaphylaxis, potential drug interactions, and opportunistic infections such as C. difficile. 
A 2019 review of guidelines confirms previous recommendations regarding antibiotic prophylaxis in the prevention of prosthetic joint infections and endocarditis following dental surgery. While most evidence is based on older case-control studies, a large 2017 retrospective study also showed no difference between PJI after dental work with or without antimicrobial prophylaxis [See Table 2]. The authors concede that PJI post-dental procedures, although rare (<0.5%), can see patients suffer significant morbidity. However, this must be balanced against adverse effects of unnecessary antibiotics, such as adverse drug reactions, contribution to antimicrobial resistance, and disruption of the gut microbiome. 
A 2021 review found 44 PJIs after dental procedures (22 in primary in total hip arthroplasty, 20 in primary total knee arthroplasty, one in revision hip repacement, and one in a hip resurfacing procedure). Antibiotic prophylaxis was documented for 5 patients. The dental procedure was invasive in 35 (79.5%). Comorbidities were present in 17 patients (38.7%). The organisms reported were Streptococcus spp. in 44%, other aerobic gram-positives in 27%, anaerobic gram-positives in 18%, and gram-negative organisms in 11%. An estimated 46% of organisms may be resistant to amoxicillin. The outcomes of treatment were reported for 35 patients (79.5%). Twenty-seven patients (61.4%) had no clinical signs of PJI at the final follow-up visit. The authors conclude lower extremity PJI associated with dental procedures is often caused by organisms unlikely to be prevented with amoxicillin. 
In a 2016 review on the use of antimicrobial prophylaxis for dental procedures in patients with prosthetic joints, the authors suggest that proof of a causative relation with dental procedures is not possible because the responsible bacteremia can originate from the oral cavity at any time regardless of when the dental procedure occurs. Large cohort studies have shown a PJI incidence of less than 1% in the first year after implantation. The overall low incidence, the low proportion of microorganisms belonging to oral flora found in prosthetic joint infection the low risk of hematogenous seeding, and the low virulence of these bacteria are arguments against antimicrobial prophylaxis during dental procedures in patients with artificial joints. Although some experts may consider the use of antimicrobial prophylaxis in rare cases (e.g. immunosuppressed transplant patients), the authors do support the generalized use of antibiotic prophylaxis for dental procedures in patients with prosthetic joints. 
A 2020 systematic review sought to reassess clinical literature to determine if there is evidence to support antibiotic prophylaxis in patients with periodontal disease as a means to decrease the risk of PJI. The authors concluded, "currently, there is no evidence to support or exclude the need of antibiotic prophylaxis as a means to decrease the risk of prosthetic joint infections in patients with periodontal disease."