Question: Do I need antibiotics for dental work after a joint replacement?
Patients who have joint replacement surgery are at risk for developing infections of the implanted joints. Bacteria can travel through the bloodstream and attach to implanted joints. Once bacteria have found implanted joints, the body's immune defense has a difficult time fighting the infection. Therefore, it is critical to avoid situations that can cause bacteria to enter the bloodstream. If these situations are necessary, as is the case with dental work, then antibiotic treatment should be given.
Answer: Antibiotic treatment before dental work in patients with joint replacement is not routinely indicated. Most patients do not need to have antibiotics prior to dental work. However, there are some situations where prophylactic antibiotics are recommended.
Current recommendations established by the American Academy of Orthopaedic Surgeons and the American Dental Association are as follows:
- All Patients (In first 2 years after joint replacement)
Patients who have recently undergone joint replacement surgery generally have antibiotic treatment prior to dental work in the first two years after their joint replacement surgery. Prior to undergoing joint replacement, all patients should have any dental issues addressed. - Immunocompromised/Immunosuppressed Patients
These include patients with rheumatoid arthritis, lupus, and other conditions that can affect the immune system. Patients who take medications or receive radiation treatment that can alter the immune system should also have antibiotics prior to dental work. - Patients With Other Medical Problems
Patients with other medical issues, including, but not limited to, the following should have antibiotics prior to dental work:- Malnourishment
- Hemophilia
- HIV
- Insulin-Dependent Diabetes
- Malignancy
- Patients With Prior Infection of a Joint Replacement
Patients who have had infection of a joint replacement implant in the past should have antibiotic treatments before dental work.
What Antibiotics Are Used?
Antibiotic recommendations may depend on factors including your ability to take oral antibiotics and any allergies you may have.Most patients can take Amoxicillin (2 grams, one hour before the dental work). If patients cannot tolerate oral antibiotics, they can take Cefazolin (1 gram) or Ampicillin (2 grams), injected within one hour of the procedure.
Patients with allergies to these medications can consider Clindamycin (600 miligrams) either oral or injected within an hour of the procedure.
References:
- Advisory Statement: Antibiotic Prophylaxis for Dental Patients With Total Joint Replacements JADA, Vol 134, July 2003.
