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Everyone knows that good dental health is important. But for people with artificial joints, a visit to the dentist can be especially significant. The bacteria that cause infections in the teeth or gums can easily travel through the bloodstream and settle in the artificial joint. That can cause even more problems than a toothache.

Representatives from the American Dental Association and the American Academy of Orthopaedic Surgeons developed the following recommendations for people with joint replacements who are planning to have some dental work done. Because there is little data on this topic, these recommendations are guidelines only. Your dentist and your orthopaedic surgeon, working together, will determine an appropriate course of treatment for you.

When do you need preventive antibiotics?

You won't need to get preventive antibiotics for most dental procedures. But because you have an artificial joint, your risk of contracting a blood-borne infection is higher than normal. So preventive treatment is advised if the dental procedure involves high levels of bacteria.

You should get preventive antibiotics before dental procedures if:

• You have an inflammatory type of arthritis such as rheumatoid arthritis or systemic lupus erythematosis.
• Your immune system has been weakened by disease, drugs, or radiation.
• You have insulin-dependent (Type I) diabetes.
• You had a joint replacement less than two years ago.
• You’ve had previous infections in your artificial joint.
• You are undernourished or malnourished.
• You have hemophilia.

What procedures require preventive antibiotics?

You should get preventive antibiotics for the following dental procedures:

• Dental extractions
• Periodontal (gum disease) procedures
• Dental implant placement and reimplantation of teeth that were knocked out
• Endodontic (root canal) instrumentation or surgery
• Initial placement of orthodontic bands (not brackets)
• Injection of a local anesthetic into the gums near the jaw
• Regular cleaning of teeth or implants where bleeding is anticipated

What kinds of antibiotics are suggested?

The following preventive antibiotics are suggested:

• If you can take oral medications and are not allergic to penicillin, 2 grams of Amoxicillin, Cephalexin, or Cephradine should be taken one hour before the procedure.
• If you cannot take oral medications and are not allergic to penicillin, 2 grams of Ampicillin or 1 gram of Cefazolin should be administered by injection one hour before the procedure.
• If you are allergic to penicillin, 600 milligrams of Clindamycin should be taken orally or administered by injection one hour before 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.