Therefore, it is critical to avoid situations that can cause bacteria to enter the bloodstream in the first place. If that is not possible, such as is the case with invasive dental work, then antibiotics are recommended.
This is now routine. In the past, administration of antibiotics prior to dental work was only recommended during the first two years after surgery. Because of concerns about the severity of infection of a joint replacement, the American Academy of Orthopaedic Surgeons now recommends that antibiotics be given before an invasive dental procedure no matter how long it has been since the joint replacement procedure.
Special CircumstancesThere are some patients who may have a higher chance of developing an infection. These people need special consideration, and certain factors should be taken into account when a doctor decides on whether or not to give the recommended antibiotics before a procedure. These individuals include:
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 issues that alter the body's ability to fight infection may also require specific medications to help prevent infection. Some of these medical conditions include:
Patients who have had infection of a joint replacement implant in the past should have antibiotic treatments before dental work. These guidelines are recommendations, and they may be altered by your dentist or your orthopedic surgeon. If you have questions about your specific situation, you should discuss any concerns with your doctor.
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, usually one hour before the dental work. If you cannot tolerate oral antibiotics, your doctor may recommend Cefazolin or Ampicillin, which gets injected within one hour of the procedure.
If you are allergic to these medications, speak to your doctor about Clindamycin (either oral or injected).
Information Statement: Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements American Academy of Orthopaedic Surgeons, 2009.