How soon can you have dental work after knee replacement

If you have had joint replacement surgery, you will remember that somewhere along the way, someone informed you that from now on you would always have to take antibiotics before your dental procedures. It became so much a part of the norm that few even thought to question it. But ongoing research and scientific evidence have changed the game. 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. As explained by the American Dental Association (ADA), 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 and was part of the regimen even though some experts recommended against this practice. Over the last decade both the ADA and the American Association of Orthopedic Surgeons have updated their guidelines suggesting that dentists
“might consider discontinuing the practice of routinely prescribing prophylactic antibiotics.” Guidelines are re-evaluated every few years to make sure that they are based on the best scientific evidence.

Should I Continue to Take Antibiotics Just in Case? 
Our careful review of the research says that you should not. 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.

Not only that, but 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 infections that cause intestinal problems. Patients over 70 years old are also at increased risk of experiencing adverse reactions to some antibiotics.

Can Antibiotic Prophylaxis Help Some People?
There are patients who are good candidates for premedication. The research shows that 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.

We recommend that you share your medical history with us and talk with your physician or orthopedist about whether you should proceed with antibiotic prophylaxis before dental treatment. Patient care is our top priority, and we always want to do what is right for you.

Please talk to us about your questions and concerns - we welcome your feedback!

Best wishes,
Dr. Jim and the Mitchell Dentistry family

Read more about it: https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis

Research provided by the American Dental Association

People who have undergone joint replacement surgery are at risk for developing infections of their implanted joints. In severe cases of infection, a person may experience the loss of bone support to the implant and require surgery to repair it.

It is for this reason that healthcare providers make every effort to counsel their patients on ways to avoid infection. Deep infection is a serious problem, affecting between 4% of primary and 15% of revision knee replacements.

There have been changing recommendations as to whether antibiotics should be mandatory for joint replacement recipients when undergoing dental work. Starting in 2012, the recommendations were modified to say that most people would not require antibiotics for routine dental work but that treatment may be given to people at the highest risk of infection.

How Implant Infection Occurs

The most common route of a bacterial infection into the body is through broken skin. While normal tissue can typically defend itself against the invading bacteria, the inorganic materials of a prosthesis (artificial body part) cannot. It is there that an infection can seed and cause damage to surrounding bone and tissue.

Another possible route involves oral infections and certain types of dental work. During a dental procedure (or any invasive medical procedure, for that matter), bacteria can often enter the bloodstream if the tissue is broken.

With little immune protection, any infection of a knee replacement and hip replacement can quickly turn serious, increasing the risk of complications and disability.

To avoid this, healthcare providers will often recommend a course of antibiotics before any invasive procedure. In this way, the natural bacteria on the skin or in the mouth will be dramatically suppressed.

While this would certainly be recommended in advance of major surgery, persons undergoing certain dental procedures may also be asked to take antibiotics before a procedure.

Current Dental Recommendations

There is often confusion (and not only among patients but healthcare providers, as well) as to who should receive antibiotics before dental work. In the past, antibiotics were commonly administered for all dental procedures for the first two years following implant surgery.

That recommendation was then extended in 2009 from two years to a lifetime. However, there was a complete turnaround in policy only three years later.

In its updated 2016 guidelines, the American Academy of Orthopedic Surgeons (AAOS) in association with the American Dental Association (ADA) stated that antibiotics are not recommended for persons undergoing routine dental work.

In defending the decision, both the AAOS and ADA stated that there was no evidence to suggest that the routine administration of antibiotics reduced the risk of joint implant infection.

Similarly, the governing bodies were unable to endorse the use of oral antimicrobials prior to dental work and only reached consensus in recommending "healthy oral hygiene" as a means of ample protection.

Special Circumstances

This is not to suggest that antibiotics should be avoided or that there aren’t circumstances for which antibiotics may be appropriate. This includes major extractions (the pulling of teeth).

There are also certain individuals who are inherently at higher risk of infection due to either a severely weakened or abnormal immune response. In many cases, these individuals are not only less able to fight infection but to control it once it occurs.

According to the AAOS/ADA guidelines, antibiotics may need to be administered prior to dental work for persons with the following conditions:

• Rheumatoid arthritis, lupus, and other autoimmune disorders for which infection can trigger sometimes severe inflammation of the joints
• People with hemophilia (a bleeding disorder) or insulin-dependent (type 1) diabetes who are at increased risk of blood-borne infections
• Immune-compromised individuals. including organ transplant recipients, persons undergoing cancer radiation therapy, and people with advanced HIV (human immunodeficiency virus) infection
• Persons who have had a past infection of a joint implant

Recommended Antibiotics

When antibiotics are recommended, healthcare providers will typically prescribe oral amoxicillin (a form of penicillin) to be taken one hour before the dental work.

If you cannot tolerate oral antibiotics, your healthcare provider may recommend injectable cefazolin or ampicillin, which are injected within an hour of the procedure. If you are allergic to these drugs, clindamycin (either oral or injected) may be used.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.

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