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American Association of Hip and Knee Surgeons

Advocacy, Education, Research

Preventing Infection in Your Joint at the Dentist’s Office

During a dental procedure, it is possible for bacteria from the mouth, teeth or gums to travel through the bloodstream and settle in an artificial joint. The use of an antibiotic pill prior to dental work has been thought to lower this risk. Orthopedic surgeons have historically recommended the routine use of antibiotics prior to dental work due to the catastrophic effects of a prosthetic joint infection and the relative safety of a single dose of oral antibiotics.

In 2013, The American Academy of Orthopaedic Surgeons and The American Dental Association worked together to create guidelines for this situation. The workgroup reviewed the available published data to try and synthesize recommendations for patients and practitioners. Unfortunately, there is not a large amount of quality data, but they issued three findings:

  1. The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.
  2. We are unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopaedic implants undergoing dental procedures.
  3. In the absence of reliable evidence linking poor oral health to prosthetic joint infection, it is the opinion of the work group that patients with prosthetic joint implants or other orthopaedic implants maintain appropriate oral hygiene.

Many factors should be considered when you are making this decision, such as:

  • The type of procedure being performed – routine cleaning vs. more invasive work
  • Your health status – patients with compromised immune systems are at greater risk
  • The presence or absence of an active infection in the mouth
  • The recommendations of your surgeon and dentist

With the lack of a definitive answer on this question, we recommend that you discuss this with your surgeon.

If your surgeon or dentist recommends antibiotics, the following antibiotics are usually used:

  • If you are NOT allergic to Penicillin, 2 grams of Amoxicillin, Cephalexin, or Cephradine taken one hour prior to the procedure.
  • If you ARE allergic to Penicillin, 600mg of Clindamycin taken orally or administered by injection one hour prior to the procedure.

Developing an infection in and around a total hip or knee replacement is one of the most catastrophic complications that can occur. If you suspect you might have an infection, it is important to seek treatment early.

References:

1.  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

2.  Appropriate Use Criteria – For the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures; http://www.orthoguidelines.org/go/auc/default.cfm?auc_id=224995&actionxm=Terms

» Next: Learn how to address implant recall concerns.

This article has been written and peer reviewed by the AAHKS Patient and Public Relations Committee and the AAHKS Evidence Based Medicine Committee.
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