Joint Replacement Patients May Require Antibiotics Before Dental Procedures
Joint replacements are usually very successful and patients can return to an active lifestyle soon after the procedure. Still, patients should be cautious about the potential for an infection. Infection of any joint replacement (hip, knee, shoulder, or another joint) is a serious concern and may even require removal of the joint replacement components.
Bacteria from your mouth can spread to your blood and from there to your joint replacement, particularly in patients with ongoing dental problems. Thus, good oral hygiene can prevent infection of a joint replacement. Even prior to having a total joint replacement, patients should aspire to achieve good dental health and resolve their dental issues. Importantly, patients with joint replacements should be diligent in maintaining daily oral hygiene.
During dental procedures, bacteria living in your mouth can spread to your blood and joint replacements. The American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) have developed guidelines for patients with joint replacements who are having dental work (including routine cleanings) or any other surgical procedures. [PDF of Patient Guidelines]
Dr. William Tomford, an Orthopaedic Surgeon at the Massachusetts General Hospital, and Professor of Orthopaedic Surgery at Harvard Medical School, Boston, MA, points to the AAOS recommendation and affirms, “bacterial infections can occur at any time in the life of a joint replacement, but the most critical period is up to two years after surgery.” Patients with rheumatoid arthritis, systemic lupus erythematosus (SLE), and other immune compromising disorders are particularly susceptible to joint infections.
Patients at Increased Risk of Joint Infections
- All patients during the first two years after joint replacement.
- Patients whose immune response is suppressed by medications, chemotherapy or radiation therapy; or patients with diseases such as rheumatoid arthritis or systemic lupus erythematosus.
- Patients with a previous joint infection, or with medical conditions, such as hemophilia; HIV infection; insulin-dependent (Type 1) diabetes, or any cancer.
If you are having any dental procedure, tell your dentist that you have a joint replacement and may require preventive antibiotics. Your dentist will recommend appropriate antibiotics before the procedure if you are within two years from your joint replacement surgery. After two years, you may still need antibiotics before dental work if your immune system is compromised, or if you have certain medical conditions putting you at a higher risk of infection. (see box below). For patients with pins, plates and screws, antibiotics before dental treatments are usually not necessary.
Dentists need to know specifically what type of implants you have in order to prescribe antibiotics. To prevent any confusion, Dr Tomford advises, “ask your orthopaedic surgeon for a note describing your surgical procedure, and give it to your dentist.”