Many people with prosthetic hips and knee joints have been taking antibiotics before dental treatment on the advice of their Orthopedic Surgeons.  They were afraid that the bacteria in the mouth could get into the bloodstream and infect the artificial joints, which could lead to having to replace the joint.  Some people were told to premedicate with antibiotics before dental visits for two years after their joint surgery.  Others were told they must do it for the rest of their lives.  If dental work leads to infected prosthetic joints, then it would surely be wise to take antibiotics before dental visits.  But does it?

The American Dental Association (ADA) and the American Association of Orthopaedic Surgeons (AAOS) completed a systemic review of the literature last month and came up with the following recommendations:

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.”

HUH?  What does this all mean?  Here’s my interpretation:

1- There is no evidence that dental treatment causes joint infections, but they’d like to see more studies done before they stick their necks out and actually say it doesn’t.  So, doctors might not want to give patients antibiotics before dental work unless/until they hear otherwise.

(If you read the fine print, there is only one good study which explored the “association between dental procedures and orthopaedic implant infection”.  It concluded, “dental procedures are not risk factors for subsequent implant infection and furthermore that antibiotic prophylaxis does not reduce the risk of subsequent infection.”

They go on to state that we know dental treatment causes bacteria to get into your bloodstream, but there are no studies at this time that show that bacteria infects prosthetic joints.)

2- We’re not really sure if rinsing with antibacterial mouth rinses right before dental work would be helpful, since there’s not much evidence either way and it doesn’t look like dental work causes joint infections anyway, but it wouldn’t hurt so if you want to keep doing it, then go ahead.

3- We think you should floss and brush well if you have artificial joints.  (Glad to know the ADA and AAOS agree on this!)

For both of the first two recommendations, they also state, “Patient preference should have a substantial influencing role.”  Translation- “whatever the patients want to do is fine with us”.

So do you need to take antibiotics before dental treatment if you have an artificial hip or knee?  Well, here’s the title of the article the AAOS put out in December- “Evidence Insufficient to Recommend Routine Antibiotics for Joint Replacement Patients Who Undergo Dental Procedures”.  Many surgeons will probably continue to recommend it.  I would recommend not to.  But it’s up to you!

Dr. Steve

Roseville Family Dentist

UPDATE: In 2014, the American Dental Association assembled an expert panel to update and clarify the clinical recommendations. They concluded that prophylactic antibiotics are not recommended for patients with prosthetic joints prior to dental procedures. You can read the clinical recommendations here.

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