Archive | October, 2013

Pre Medication Joint Replacement

22 Oct

If you have a Joint replacement such as a hip or knee and you are confused as to the need for antibiotics before your dental appointment , you have every right to be. The bottom line is however, yes , yes and yes …  forever ..(for now)..

Let  me try to explain a little more about this issue.Approximately 7 years ago the American Medical Association, American Dental Association and the American Orthopedic Association all met and finally came to an agreement that there was no scientific basis for requiring that patients  with joint replacements needed to take antibiotics before dental procedures. The Orthopedic Association had years ago  decided that this was necessary to prevent bacteria from your mouth getting into the blood steam and causing their prosthetic devices to become infected and fail.There  was no real scientific findings to justify the this conclusion but it sounded good to the Orthopedists to explain as to ,why they were ,on occasion, failing.

The outcome of that meeting was a revision to the old recommended guidelines. A compromise was reached that patients need only pre-medicate  for two years  after the placement of their replacement joint then no more pre-medication !

Everything went along just fine until about two years ago the Orthopedic Association unilaterally decided to go against the panel decision and return to their old guidelines.Once again ,the science does not support their beliefs but Dentistry is kind of caught in a no win situation.If a dentist advises not to pre-medicate and goes against the current guidelines if a patient’s prosthetic replacement fails, for WHATEVER reason after the dental procedure, guess who will be blamed ? Yes the dental office!

 I wrote this blog in response to a patient’s excellent question today.” If I have to take antibiotics to protect my new hip from being damaged when I have my teeth cleaned how do I not damage it every day when I floss my teeth?”I asked her if she had asked her orthopedist that question he said yes she had and he mumbled something about Dentistry “sweeping that one under the rug”!! Are you kidding me?Of course common sense and science says that if oral bacteria were truly a cause and effect that all prosthetic patients who flossed would cause rejection of the joint! As Abbott said to Costello”Who’s on first?”

  Just medicate and no one gets sued.(This is sarcasm !)


 Dr Gary