Q: Do I Need to Take a Pre-Medication for my Prosthetic Joint?
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 is from 2016 and is called Appropriate Use Criteria from the American Academy of Orthopedic Surgeons. Simply go on their website, answer 5 questions and hit submit and the AAOS’s website will tell you if a pre-medication is indicated or not.
- Search https://www.aaos.org/auc/
- Click on Management of Patients with Orthopaedic Implants Undergoing Dental Procedures that will take you to a page that provides information about the 5 questions that you will answer on the next page.
- Scroll to the bottom and click the blue box that states I have read and understood the assumptions and disclaimer.
- Answer the 5 questions. Assume that we will always be manipulating the gingiva so answer yes to question 1.
- Click on Submit at the bottom of the page and it will tell you if a pre-medication of antibiotics is indicated or not.
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 and there are no staphylococcus bacteria present in the mouth.
Antibiotic resistances are becoming a huge problem and are becoming one of the biggest public health challenges today. Antibiotics fight bacteria in your body. Bacteria are smart and want to live in your body. Bacteria figured out that if they change their composition just a little so that the antibiotics cannot destroy them, then they can grow and thrive, which is called antibiotic resistance.
We are running out of antibiotics to fight certain bacteria and in fact there haven’t been any new antibiotics developed since 1987. 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. Each year in the United States, 2 million people get an antibiotic resistant infection, and at least 23,000 people die.