Antibiotics Before Dental Work

Do Joint Replacement Patients Require Antibiotic Treatement Before Dental Work

dentist replacement antibiotics
Talk to your doctor if you think you need antibiotics before dental work. Thinkstock / Getty Images

Patients who have joint replacement surgery are at risk for developing infections of their implanted joints.  During dental procedures and other invasive medical procedures, bacteria can enter the bloodstream and circulate through the body.  If bacteria traveling through the bloodstream find implanted joints, the body's immune system has a difficult time fighting the infection.  Infection of a knee replacement and infection of a hip replacement are serious complications.

Therefore, it is critical to avoid situations that can cause bacteria to enter the bloodstream in the first place. If that is not possible, such as is the case with some invasive medical procedures, including some types of dental work, then antibiotics may be recommended.

There has been confusion, among doctors, dentists, and patients, about who should have antibiotics before having dental work. In the past, administration of antibiotics prior to dental work was only recommended during the first two years after surgery. Then the recommendation was changed in 2009 to advise routine antibiotic administration in joint replacement patients for their lifetime.  The latest recommendation from 2012 is that antibiotics are NOT mandatory for patients undergoing routine dental work after having a total joint replacement.  This statement was endorsed by both the American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA).

The most recent recommendation was based on the fact that there was no evidence to support the use of routine antibiotic administration for patients having dental work.  As stated, this is different from prior recommendations.  If you hear a different recommendation from your surgeon it could be that they are not familiar with the most recent information, or it could be that they have other special considerations for your specific circumstance.


Special Circumstances

There are some patients who may have a higher chance of developing an infection. These people need special consideration, and certain factors should be taken into account when a doctor decides on whether or not to give the recommended antibiotics before a procedure. These individuals include:

Immunocompromised/Immunosuppressed Patients
These include patients with rheumatoid arthritis, lupus, and other conditions that can affect the immune system. Patients who take medications or receive radiation treatment that can alter the immune system should also have antibiotics prior to dental work.
Patients With Other Medical Conditions Effecting Immune Defenses
Patients with other medical issues that alter the body's ability to fight infection may also require specific medications to help prevent infection. Some of these medical conditions include:

Patients With Prior Infection of a Joint Replacement
Patients who have had an infection of a joint replacement implant in the past should have antibiotic treatments before dental work.

These guidelines are recommendations, and they may be altered by your dentist or your orthopedic surgeon. If you have questions about your specific situation, you should discuss any concerns with your doctor.

What Antibiotics Are Used?

When antibiotics are recommended, most patients take Amoxicillin, usually one hour before the dental work. If you cannot tolerate oral antibiotics, your doctor may recommend Cefazolin or Ampicillin, which is injected within one hour of the procedure.  If you are allergic to these medications, your doctor may recommend an alternative antibiotic, usually Clindamycin (either oral or injected).


AAOS, ADA Release CPG for Prophylactic Antibiotics American Academy of Orthopaedic Surgeons, 2012.

Barclay L. "Guideline: Antibiotics Need Not be Routine for Dental Work" Medscape Medical News. December 21, 2012.

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