Joint Replacements and Antibiotic Coverage
At the Silberman Dental Group, my staff and I stay current with information and treatment techniques. At a Continuing Education course on June 20, 2013, the subject of Joint Replacement and the use of Antibiotic Therapy was discussed.
The Controversy: Should a patient with an artificial joint be treated with antibiotics prior to their appointment? Right now, the answer is MAYBE.
The Problem: There are bacteria in the mouth that enter the bloodstream during routine dental treatment. They do not pose a threat to the healthy individual. But these bacteria can create plaques that form on implants. These plaques can break off and be taken by the circulation to other areas of the body causing blockages in the heart or brain.
The “Solution”?: Treat the patient with antibiotics one hour before dental treatment. This will kill the bacteria that enter the circulation that are introduced from the mouth by the dentist or dental hygienists.
The History: In 2003. The American Association of Orthopedic Surgeons stated “the risk/benefit and cost/effectiveness ratios fail to justify the administration of routine antibiotic prophylaxis for patients with total joint replacements.” In 2009, the same organization (AAOS) stated, “given the potential adverse outcomes and cost of treating and infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint patients prior to any procedure that may cause bacteremia.” In 2012, AAOS released guidelines that do not support routine prescription of antibiotic prophylaxis for joint replacement patients undergoing dental procedures. So which is right: pre-treat with antibiotics for joint replacement or not?
Today: At the Silberman Dental Group, we agree with some Orthopedists who suggest antibiotic prophylaxis for joint replacement prior to dental treatment for two years after the surgery. The exposed areas of metal are completely sealed in bone by that time and do not pose further risk to the patient. For the first two years, we will provide the patient with the prescription for antibiotics. If an orthopedist feels strongly that a patient should pre-medicate after 2 years, the orthopedist can prescribe the antibiotic for the patient.