Old Man at Dentist

Why Patients with Joint Replacement No Longer Need Antibiotics Before a Dental Visit

Older patients often undergo total joint replacement, which involves the surgical installation of a prosthetic joint to replace one damaged by arthritis or other conditions. Performed correctly, this can significantly increase quality of life by improving movement and reducing pain.

Some joint replacement patients have heard conflicting information about whether and when they should use antibiotics. In particular, they might have been told that it’s important to utilize antibiotics before any dental procedure – but this is not the case.

Recent research has reversed conventional wisdom about antibiotics for those with total joint replacement. The drawbacks are significant and the expected benefits have all but evaporated.

Antibiotic Prophylaxis Has Little Impact on Infection Rates

Antibiotic prophylaxis is the term for introducing antibiotics into a patient’s body before starting a medical procedure. It is sometimes used in dentistry as well as various forms of surgery.
Antibiotic prophylaxis was once common for patients believed to be at an unusual risk of infection. In particular, many total joint replacement patients have been told that antibiotics will prevent bacteria in the mouth from infiltrating the bloodstream during treatment.

However, it was long suspected that mouth bacteria posed very minimal risk to these patients. Recent studies have demonstrated that most prosthetic joint infections occur for other reasons, and few are related to dental procedures.

In fact, the majority of bacteria involved in prosthetic infections are found on the surface of skin.

Recommendations for Those With Total Joint Replacement

After a long period of intensive research, the Canadian Dental Association joined with two other major Canadian medical organizations to provide additional guidance.

To summarize, they found:

  • Patients shouldn’t be exposed to antibiotic prophylaxis, as there is no evidence of benefit
  • Antibiotic prophylaxis is not indicated for dentistry patients with total joint replacement
  • Orofacial infection in all patients should be treated to eliminate it and prevent its spread

In general, patients should be judicious about when antibiotics are appropriate. These medications may disturb the balance of positive bacteria in the gastrointestinal tract, eliminating the body’s key defenses against certain harmful bacteria, such as C.difficile – which is associated with severe diarrhea.

At Coscarella Family Dentistry, we are always striving to ensure that our patients enjoy the highest standards of treatment in a comfortable, caring environment. Following the latest protocols on antibiotic prophylaxis is part of that commitment.


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