I heard I may need antibiotics for dental work after a joint replacement. True?

Question: I heard I may need antibiotics for dental work after a joint replacement. True?

Answer: It may sound curious, but yes. Patients who have joint replacement surgery are at risk for developing infections of the implanted joints. Once bacteria that has traveled through the bloodstream find implanted joints, the body's immune system has a difficult time fighting the infection.

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 Circumstances

There 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:

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 Conditions Effecting Immune Defenses
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:

• HIV
• Insulin-dependent diabetes
• Malnourishment
• Hemophilia
• 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. 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).

_Sources:

_{Information Statement: Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements American Academy of Orthopaedic Surgeons, 2009.}