Joint Replacement

 

A thorough dental examination for presence of tooth and gum infection is recommended prior to joint replacement. Periodontal disease is a commonly occurring oral infection of the adult population destroying the bony support of the teeth.  Because of the lack of any discomfort to the patient in its early stages, many adults are unaware that they have this infection. The bacteria from this bone destroying disease, especially in advanced cases, have been attributed to possible infection in joint replacements.

 

The American Academy of Orthopedic Surgeons (AAOS) updated their recommendations regarding the need for antibiotic prophylaxis (also called pre-medication or pre-med) in patients with joint replacements prior to any procedure that might introduce bacteria into the bloodstream. Receiving dental treatment is considered to be one of the procedures that can cause bacteremia.

 

In the past, administration of antibiotics prior to dental work was only recommended during the first two years after surgery. Due to concerns about the possibility of infection following joint replacement, some Orthopedic Physicians still recommend that antibiotics be given before dental procedures no matter how long it has been since the joint replacement procedure. Antibiotics should be taken 1 hour prior to the dental procedure. These recommendations do not apply for patients with pins, screws, or other orthopedic hardware that is not within a synovial joint.

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Based on careful review of the scientific literature, the American Dental Association found that dental procedures are not associated with prosthetic joint implant infections, and that antibiotics given before dental procedures do not prevent such infections.

In fact, 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 C. difficile infection, which causes diarrhea and other intestinal problems. 

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Your orthopedic surgeon should be personally consulted, prior to your appointment; to know for sure whether premedication is recommended in your particular case.

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