Pre-Medication, Prosthetic Joint Infections and Dental Care

By Dr. Cheryl Bresnahan

There is controversy among the American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA) regarding the need for pre-medication prior to dental appointments.  Orthopedic surgeons have gone back and forth as to how long after a weight bearing prosthetic joint has been placed and the need for pre-medication prior to dental visits.

The current recommendation has been changed back to forever (from 2 years after a joint has been replaced) by the AAOS even though there is no scientific evidence that demonstrates an association between a dental procedure and a prosthetic joint infection. Most of the infections in the joints have been associated with Staphylococcus bacteria.  In dentistry, we deal with Streptococcus bacteria.

The main reason the ADA is fighting the orthopedic surgeons is because there is a health risk with taking antibiotics when they are not needed including  fatal anaphylaxis (death caused by an allergic reaction to an antibiotic), change the gut bacteria that can develop diarrhea and vomiting and some may require a hospital stay and can be life threatening, drug resistance, and all of these adverse reactions increase with increasing age and most people that have prosthetic joints are at an increased age.

Antibiotic resistances are becoming a huge problem.  Antibiotics fight bacteria in your body.  Bacteria are smart and want to live in your body.  The bacteria figured out that if they change their composition just a little so that the antibiotics cannot destroy them and then they can grow and thrive, which is called antibiotic resistance.  We are running out of antibiotics to fight certain bacteria.  Some antibiotics that have worked in the past have very little effect today.  Bottom line is that the more often a person takes an antibiotic, the more resistant their body can become to antibiotics and at the end, if you have a bacterial infection that no antibiotics will work on, the result is death.

The ADA does reference some extenuating circumstances that may have an impact on the development of a prosthetic joint infection with the 2 main factors most associated with prosthetic joint infections were having a previous cellulitis or having 4 or more comorbidities (a person has COPD, diabetes, hypertension, and had a heart attack).  Other concerns are if there was wound drainage, a hematoma, or a urinary tract infection after the prosthetic joint was placed.   The high risk time frame of developing a complication following placement of a prosthetic joint is before 6 months, but not at 2 years.

Although there is no data to support whether a pre-medication would have decreased the risk of developing a prosthetic joint infection, the above issues may dictate whether the risk of taking a pre-medication is worth the benefit.

Dr. Cheryl Bresnahan is a licensed dentist and the founder of Dental Perfections in Whitewater, WI. If you'd like to ask her a question, please visit the Ask Dr. Cheryl section of our Web site.