If I have had a joint replacement, do I need antibiotics before dental procedures?

May 25 • 2 minute read

If you have had joint replacement surgery, you will remember that somewhere along the way, someone informed you that from now on you would always have to take antibiotics before your dental procedures. It became so much a part of the norm that few even thought to question it. But ongoing research and scientific evidence have changed the game. The American Dental Association has found it is no longer necessary for most dental patients with orthopedic implants to have antibiotic prophylaxis to prevent infection.

What Is Antibiotic Prophylaxis?
Antibiotic prophylaxis (or premedication) is simply the taking of antibiotics before some dental procedures such as teeth cleaning, tooth extractions, root canals, and deep cleaning between the tooth root and gums to prevent infection. As explained by the American Dental Association (ADA), we all have bacteria in our mouths, and a number of dental treatments—and even daily routines like chewing, brushing or flossing—can allow bacteria to enter the bloodstream (bacteremia). For most of us, this isn’t a problem. A healthy immune system prevents these bacteria from causing any harm. There is concern, however, that bacteria in the bloodstream could cause infection elsewhere in the body.

Prior to 2012, premedication prior to dental procedures was common for joint replacement patients and was part of the regimen even though some experts recommended against this practice. Over the last decade both the ADA and the American Association of Orthopedic Surgeons have updated their guidelines suggesting that dentists
“might consider discontinuing the practice of routinely prescribing prophylactic antibiotics.” Guidelines are re-evaluated every few years to make sure that they are based on the best scientific evidence.

Should I Continue to Take Antibiotics Just in Case? 
Our careful review of the research says that you should not. The ADA found that dental procedures are not associated with prosthetic joint implant infections, and that antibiotics given before dental procedures do not prevent such infections.

Not only that, but for most people the known risks of taking antibiotics may outweigh the uncertain benefits. Risks related to antibiotic use include nausea, upset stomach and allergic reactions, including anaphylactic shock (a severe allergic reaction that can be life threatening). Other risks include developing antibiotic resistance in bacteria, which can complicate treatment of infections such as strep throat, pink eye and meningitis; as well as increasing the risk of infections that cause intestinal problems. Patients over 70 years old are also at increased risk of experiencing adverse reactions to some antibiotics. 

Can Antibiotic Prophylaxis Help Some People?
There are patients who are good candidates for premedication. The research shows that antibiotic prophylaxis might be useful for patients undergoing dental procedures who also have compromised immune systems (due to, for instance, diabetes, rheumatoid arthritis, cancer, chemotherapy, and chronic steroid use), which increases the risk of orthopedic implant infection. It may also benefit others with heart conditions.

We recommend that you share your medical history with us and talk with your physician or orthopedist about whether you should proceed with antibiotic prophylaxis before dental treatment. Patient care is our top priority, and we always want to do what is right for you.

Please talk to us about your questions and concerns - we welcome your feedback!

Best wishes,
Dr. Jim and the Mitchell Dentistry family

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Research provided by the American Dental Association

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