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Practice Policy Update regarding COVID-19

Dental work after a joint replacement

It is possible, in some situations, for bacteria from the mouth, teeth or gums to travel through the bloodstream and settle in an artificial joint. In an attempt to prevent this occurrence representatives from the American Dental Association and the American Academy of Orthopedic Surgeons developed the following recommendations for people with joint replacements who are planning on having certain dental procedures done. These are guidelines only. Because your dentist knows the extent of any dental work you may require he is the best person to determine whether a course of antibiotic treatment is appropriate for you. If antibiotics are necessary, your dentist should write the prescription for you.

When do you need preventive antibiotics?

You won’t need to get preventive antibiotics for most dental procedures. But because you have an artificial joint your risk of contracting a blood borne infection is higher than normal. So preventive
treatment is advised if the dental procedure involves high levels of bacteria.

You should get preventive antibiotics before dental procedures if:

  • You have an inflammatory type of arthritis such as rheumatoid arthritis or systemic lupus
  • Your immune system has been weakened by disease, drugs or radiation
  • You have insulin-dependent diabetes (type 1)
  • You had a joint replacement less than 2 years ago
  • You’ve had previous infections in your artificial joint
  • You are undernourished or malnourished
  • You have hemophilia

If you fall into one of the above categories which procedures require antibiotics?

  • Dental extractions
  • Periodontal (gum disease) procedures
  • Dental implant placement and re-implantation of teeth that were knocked out
  • Endodontic (root canal) instrumentation or surgery
  • Initial placement of orthodontic bands (not brackets)
  • Injection of a local anesthetic into the gums near the jaw
  • Regular cleaning of teeth or implants where significant bleeding is anticipated

What kinds of antibiotics are suggested?

  • If you can take oral medications and are not allergic to penicillin, 2 grams of Amoxicillin, Cephalexin or Cephradine should be taken one hour before the procedure.
  • If you cannot take oral medications and are not allergic to penicillin, 2 grams of Ampicillin or 1 gram of Cefazolin should be administered by injection one hour before the procedure.
  • If you are allergic to penicillin, 600mg of Clindamycin should be taken orally or administered by injection one hour before the procedure.

Professional Memberships

  • Anderson Orthopaedic Research Institute
  • American Academy of Orthopaedic Surgeons
  • American Association Of Hip and knee Surgeons
  • American Osteopathic Academy Of Orthopedics
  • International Congress For Join Reconstruction
  • Nebraska Medical Association
  • Methodist Physicians Clinic
  • MD West ONE
  • Midwest Surgical Hospital