The need for artificial joints, including total hip and knee replacement, are often caused by chronic ailments commonly found in older people, such as severe arthritis. Artificial joints are also used when damage occurs due to trauma or fractures that will not heal. The placement of artificial joints has doubled in the past decade, numbering about 400,000 annually.
For years, dentists have been advised to prescribe antibiotics -- either penicillin or erythromycin -- to patients before and after receiving dental treatments to prevent infection of their prosthetic joints. Orthopedic surgeons have also strongly advocated the use of antibiotics prior to dental treatment on their patients with artificial joints. These recommendations are based on the possibility that bacteria from the mouth can enter the bloodstream (bacteremia) during dental treatment and cause infection of the joint after the surgery.
Very little research supports the routine use of antibiotics prior to dental treatment for patients with artificial joints. In fact, of the 20 to 30 known cases of potential dental infection of artificial joints, careful examination of those studies reveal that the bacteria infecting those joints -- staphylococci and beta-hemolytic streptococci -- are rarely released into the bloodstream during dental procedures.
Other flaws in those studies cast serious doubt that dental treatment was the likely cause of those late artificial joint infections. In fact, the American Dental Association's (ADA) Council on Dental Therapeutics and The American Academy of Oral Medicine have published statements indicating a lack of evidence supporting the routine use of antibiotics prior to dental treatment on patients who have artificial joints.
The ADA's council recommends antibiotics prior to dental treatment for high-risk patients only. A few studies by orthopedic surgeons do recommend that antibiotics be considered for patients that are potentially at high risk for infection of their artificial joints. High-risk patients are those who have had an artificial joint replaced in the past; have had artificial joint infections in the past or have an unstable artificial joint; have severe rheumatoid arthritis; are on steroid therapy; or have diseases or take medications that suppress the immune system.
Research has shown that the dental health of a patient is much more important regarding the potential infection of a prosthetic joint than whether antibiotics are taken before dental treatment. People who have poor dental hygiene, gum disease and other untreated dental infections put themselves at possible risk of infecting their artificial joints. In these people, the simple act of brushing teeth or eating can release bacteria into the bloodstream. For this reason, people who need surgery or have had surgery for a prosthetic joint are required to have all dental infections treated. Regular dental exams and dental cleanings at least twice a year and good oral hygiene are also of vital importance.
The use of antibiotics should not be taken lightly. The emergence of drug resistant bacteria, side effects and potentially dangerous allergic reactions are all reasons for dentists and physicians to be very prudent in the administration of antibiotics.
Dentists should take certain precautions when treating high-risk artificial joint replacement patients. The dentist may consider having those patients rinse with a potent antiseptic mouth rinse, such as Peridex® (chlorhexidine gluconate) before certain procedures. The dentist should also consult with the patient's orthopedic surgeon to discuss the appropriate use of antibiotics for high-risk patients. If antibiotics are needed, cephalexin or clindamycin are usually the drugs of choice.
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