Need for antibiotics up to dentist and orthopedic surgeon

For many years, both dentists and orthopedic surgeons have advised that patients take antibiotics before receiving dental treatment to prevent infection of their artificial joints. These recommendations are based on the possibility that bacteria from the mouth can enter the bloodstream during dental treatment and cause infection of the joint. Over the last several years, this need for antibiotics has been questioned by researchers in the dental community due to a lack of convincing scientific studies.  In June of 2010, the American Academy of Orthopedic Surgeons (AAOS) released a revised information statement that recommended the need for antibiotics prior to dental treatment for patients with artificial joints, but left the decision ultimately at the discretion of the dentist and orthopedic surgeon.

“The consequences of infection of an artificial joint can be disastrous” says Dr. Matt Austin, Director of Joint Replacement Services for the Rothman Institute. The dentist and orthopedic surgeon must weigh the risk of giving the antibiotic against the potential for infection of the artificial joint by not giving it. The decision to use antibiotics prior to dental treatment is based on three major factors: the type of dental procedure being performed, the general health of the patient, and the risk of a dangerous reaction to the antibiotic.  Antibiotics should only be considered for dental treatment that will cause bleeding such as extraction of teeth and other oral surgical procedures, teeth cleaning, and gum treatment.  Patients most at risk for artificial joint infection are those who have had an artificial joint replaced in the past, have rheumatoid arthritis or lupus, have diseases  like diabetes or HIV infection or take medications such as steroids that suppress the immune system, and have had an artificial joint placed within the last two years.  Some patients have multiple allergies to antibiotics and the risk of a serious complication from giving the antibiotic far outweighs the risk of infecting the artificial joint during dental treatment.

Prevention of dental infection prior to joint replacement surgery is also important.  In most cases, I suggest that the person who requires total joint replacement see their dentist at least two months prior to surgery, receive a dental cleaning, and a full mouth series of x-rays (about 18 x-rays in most cases). To receive a dental clearance, the patient must have all dental cavities, gum disease, abscessed teeth, fractured teeth or fillings, loose teeth, and most oral pathology found on the soft tissues of the mouth treated. Treatment not only cures the existing infection, but greatly reduces the likelihood an infection will occur in the future.  “The Rothman Institute has been requiring a dental clearance for decades,” says Dr. Austin. “Given the severity and consequences of a total joint replacement infection, we have strived to reduce the patient’s risk of developing an infection in their total joint replacement by requiring a dental clearance prior to joint replacement.”

People who have poor dental hygiene, gum disease, and other untreated dental infections put themselves at possible risk of infecting their artificial joints. Regular dental examinations and cleanings at least twice a year, completing recommended dental treatment and good oral hygiene are vital to help prevent infection of artificial joints and for overall dental health.