Antibiotic Prophylaxis: Prosthetic Joints and Orthopedic Implants

X-ray showing a joint replacement
If you have had a joint replacement and taken antibiotics before dental work in the past, you may not need to make a trip to the pharmacy before your next procedure. The American Dental Association has found it is no longer necessary for most dental patients with orthopedic implants to have antibiotic prophylaxis to prevent infection.

What Is Antibiotic Prophylaxis?

Antibiotic prophylaxis (or premedication) is simply the taking of antibiotics before some dental procedures such as teeth cleaning, tooth extractions, root canals, and deep cleaning between the tooth root and gums to prevent infection. We all have bacteria in our mouths, and a number of dental treatments—and even daily routines like chewing, brushing or flossing—can allow bacteria to enter the bloodstream (bacteremia). For most of us, this isn’t a problem. A healthy immune system prevents these bacteria from causing any harm. There is concern, however, that bacteria in the bloodstream could cause infection elsewhere in the body.

Prior to 2012, premedication prior to dental procedures was common for joint replacement patients, even though there was little evidence to support the practice and experts recommended against its practice for most dental patients. In 2012, the American Dental Association and American Association of Orthopedic Surgeons published updated guidelines, stating that dentists “might consider discontinuing the practice of routinely prescribing prophylactic antibiotics”. In January 2015, the ADA’s Council on Scientific Affairs issued another guideline, which continued to discourage prophylactic antibiotic use for most patients with prosthetic joint implants. Guidelines are re-evaluated every few years to make sure that they are based on the best scientific evidence.

Why Don’t I Need Antibiotic Prophylaxis?

Based on careful review of the scientific literature, the ADA 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. Patients over 70 years old are also at increased risk of experiencing adverse  reactions to some antibiotics.

Who Can Antibiotic Prophylaxis Help?

Depending on your personal medical history, you may still be a candidate for premedication. For example, antibiotic prophylaxis might be useful for patients undergoing dental procedures who also have compromised immune systems (due to, for instance, diabetes, rheumatoid arthritis, cancer, chemotherapy, and chronic steroid use), which increases the risk of orthopedic implant infection. It may also benefit others with heart conditions. Always talk with your dentist or physician about whether antibiotic prophylaxis before dental treatment is right for you.