The concern with dental work after joint replacement is a possibility of inducing infection. Bacteria from your mouth can enter your blood stream and settle onto your implant. Approximately 6-13% of total joint infections involve bacteria primarily found in your mouth. The highest rate of infection is within the first 2 years after surgery. While this does not directly mean that bacteria from the mouth cause joint infections, the association is strong and concerning if you happen to be unlucky!
In 2003, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) first published guidelines regarding antibiotic use for dental procedures following hip and knee replacement. These recommendations have been addressed twice by this joint panel since that time, with the latest publication in 2012 suggesting that the data is not strongly for or against antibiotics before dental work. Ultimately, the [social_warfare buttons=”Facebook, Linkedin”][social_warfare]decision to use antibiotics for dental procedures should be made with consideration of each patient’s health and surgery.
When do we recommend antibiotics?
Most dental procedures do not require antibiotics, but because you have an artificial joint, we often recommend extra precaution to limit the risk of mouth bacteria seeding the joint through the bloodstream.
You should take preventive antibiotics before dental procedures if:
- You have an inflammatory type of arthritis such as rheumatoid arthritis or lupus
- Your immune system has been weakened by disease, drugs or radiation.
- You had a joint replacement less than 2 years ago
- You’ve had previous infections in your artificial joint
- You are undernourished or malnourished
- You have hemophilia
- You have cancer or are in remission
For procedures that have a higher risk of gum bleeding, we also advise antibiotic prophylaxis:
- Dental extractions
- Periodontal (gum disease) procedures
- Placement of dental implants
- Endodontic (root canal) surgery
- Initial placement of orthodontic bands (not brackets)
- Regular cleaning of teeth or implants where significant bleeding is anticipated
Antibiotics for Dental Procedures
- If you are NOT allergic to Penicillin, 2 grams of Amoxicillin or Cephalexin taken one hour prior to the procedure.
- If you ARE allergic to Penicillin, 600mg of Clindamycin taken orally prior to the procedure.
We are here to answer all of your questions and to address any of your hip/knee needs. Contact Dr. Werger at The Bone and Joint Center for a consultation today!
(617) 779-6500
Watters, W III, Rethman, MP, Hanson, NB, et al: AAOS-ADA Clinical Practice Guideline Summary: Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. Journal of the American Academy of Orthopedic Surgeons. March 2013; 21:180-189.; doi:10.5435/JAAOS-21-03-180
