By Dr. Richard Wolfert, DMD   

The Toothboss, 

If you’ve had knee or hip replacement surgery, the risk of getting a bacterial infection in the newly placed joint has historically been a big concern, especially when dental treatment is initiated after the surgery is complete. That’s why orthopedic surgeons have typically prescribed antibiotics before any dental treatments, until recently. 

Why the concern? 

The fear surgeons have had is the bacteria from your mouth that gets into your bloodstream during a visit to the dentist can cause a condition called prosthetic joint infection (PJI). These infections can be serious. In some cases, it can require more surgery and long-term antibiotics and/or replacement of the new joint. And after undergoing a knee or hip replacement, more surgery is about the last thing you want! 

Hence, doctors have historically played it safe and prescribed antibiotics before dental visits for those patients. 

The new guidelines 

The American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA) now say most patients don’t need antibiotics before dental procedures. This change reflects a better understanding of the risks and benefits of using antibiotics. 

Why the change? 

There are a several reasons that led to this shift in thinking: 

1. Risk check. There is no evidence to support an association between dental procedures and risk of experiencing prosthetic joint infections. Most PJI cases are for reasons not even related to dental visits. For a majority of patients, antibiotic prophylaxis is not recommended for invasive dental procedures. 

2. Antibiotic resistance. Antibiotics are overprescribed in dentistry, leading to increasing challenges and bacterial resistance. That’s a big problem. So, cutting back on antibiotics when not really needed helps fight this issue. 

3. Dentists may still want to defer to the orthopedic surgeon in making the final decision. Surgeons will look at PJI infection risk on a case-by-case basis and focus on each patient’s individual risk factors for PJI. Things like past infections, a weakened immune system, and a history of diabetes can point to the need for antibiotic coverage for a patient needing dental treatment. And therefore the surgeon should be the one writing the prescription if it’s needed. 

What to do as well. The following steps can also minimize your infection risk: 

Keep your mouth healthy. All the things you should be doing anyway – regular brushing, flossing, and dental check-ups – help keep your mouth in good shape and reduce bacteria. 

Talk to your doctors. Keep both your orthopedic surgeon and dentist up to date about your medical history. Ideally, both doctors can decide together if you need antibiotics based on your individual situation. 

Be self-aware. Signs of infection can include increased pain, swelling, or fever. If you experience any of these symptoms after your dental appointment, reach out to your physician ASAP.  

Conclusion: Despite routine lifelong premedication recommendations by orthopedic surgeons, scientific evidence to support this is lacking. Clinicians are urged to reduce antibiotic use because of challenges posed by antibiotic-resistant “super bugs.” The key is starting and maintaining an open dialogue between you and your healthcare team to ensure the best outcomes for your mouth and your prosthetic joints, wherever they may be. 

About the Author: Dr. Richard Wolfert, DMD is the owner of The Toothboss, 1121 Main St., South Weymouth. For more information, call 781-335-0604 or visit