A patient with a total joint replacement may or may not require antibiotic prophylaxis before a dental procedure, depending on the patient's underlying medical conditions and the likelihood of bacteremia during the procedure.


Patients with orthopedic pins, screws or plates are not at increased risk for hematogenous infection, and antibiotic prophylaxis is not indicated before dental procedures.


Patients at potential for increased risk of hematogenous total joint infection:

(1) inflammatory arthropathies (rheumatoid arthritis, SLE)

(2) immunosuppression (disease, drug or radiation induced)

(3) insulin dependent diabetes

(4) first two years after total joint placement

(5) previous prosthetic joint infection

(6) malnourishment

(7) hemophilia


Dental procedures with higher incidence of bacteremia:

(1) dental extractions

(2) periodontal procedures including surgery, subgingival placement of antibiotic fibers or strips, scaling and root planing, probing, recall maintenance

(3) dental implant placement

(4) reimplantation of avulsed teeth

(5) endodontic (root canal) instrumentation or surgery only beyond the apex

(6) initial placement of orthodontic bands but not brackets

(7) intraligamentary local anesthetic injections

(8) prophylactic cleaning of teeth or implants where bleeding is anticipated


Dental procedures with lower incidence of bacteremia:

(1) restorative dentistry (operative and prosthodontic) with or without retraction cord; includes restoration of carious or missing teeth

(2) local anesthetic injections (nonintraligamentary)

(3) intracanal endodontic treatment; postplacement and buildup

(4) placement of rubber dam

(5) postoperative suture removal

(6) placement of removable prosthodontic/orthodontic appliances

(7) taking of oral impressions

(8) fluoride treatment

(9) taking of oral radiographs

(10) orthodontic appliance adjustment


Prophylactic antibiotics should be considered only if :

(1) the patient has had a total joint replacement


(2) the patient is in group at increased risk for hematogenous total joint infection


(3) the dental procedure is one with a higher incidence of bacteremia.


NOTE: The recommendations for prophylaxis by type of dental procedure parallels those made for prevention of bacterial endocarditis.


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