Representatives from the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) has issued a position statement regarding antibiotics for dental patients with total joint replacement(s).

The advisory board recommends the following people to get antibiotics whose risk of contracting a blood-borne infection is higher than normal.

• the patient is immuno-compromised (insulin-dependent (Type 1) diabetes, rheumatoid arthritis, systemic lupus erythematosis, hemophilia, or if your immune system is weakened by other diseases, drugs, or radiation.)

• the dental procedure is likely to have a higher incidence of bacteremia such as routine cleaning, tooth extraction, root canal or dental implants.

• dental procedures performed within two years of the total joint replacement.

• the patient has had a previous prosthetic joint infection.  

Because a joint infection is a very serious complication after a joint replacement it is important you recieve antibiotics, our recommendations are:

ALL patients having had total joint replacement who undergo any dental procedure should receive antibiotic prophylaxis for the following antibiotic prophylaxis regimen:

1.  Patients not allergic to penicillin: Cephalexin or amoxicillin, 2 gm. orally one hour prior to dental procedure.
2.  Patients not allergic to penicillin and unable to take oral medications: Cefazolin 1 gm.; or ampicillin, 2 gm. IM/IV one hour prior to the procedure.
3.  Patients allergic to penicillin: Clindamycin, 600 mg. orally one hour prior to dental procedure.
4.  Patients allergic to penicillin and unable to take oral medications:  Clindamycin, 600 mg. IM/IV one hour prior to the procedure.

These guidelines are designed to help doctors and dentists make decisions about preventive antibiotics for dental patients with artificial joints. It is not a standard of care or a substitute for the practitioner's clinical judgment, because it is impossible to make recommendations that would cover every situation. Practitioners must exercise their own clinical judgment in determining whether or not preventive antibiotics are appropriate.