Dental Treatment for Patients with Artificial Joints

Posted by Dr. Edward Magida | Filed under , , , , ,

Today's dentists are presented with a myriad of patients who have prosthetic joints, pins, screws and/or plates of some type. These patients need to have special consideration as far as how to keep these devices infection free. For many years there were conflicting ideas about the need to premedicate these people. The prevailing thoughts ranged from condemning the use of all prophylactic antibiotics for all dental procedures, to the complete opposite, which was to use antibiotics for all types of treatment on all patients, all the time for life.

In 1997, The American Dental Association, in conjunction with the American Academy of Orthopaedic Surgeons issued an advisory regarding antibiotic prophylaxis guidelines. This advisory stated that antibiotic premedication is not needed for patients who have pins, screws or plates, and it is also not indicated for the majority of dental patients who have total joint replacements. The advisory stated that only for those patients who would be at increased risk for blood borne total joint infection, should antibiotics be considered.

The following conditions or diseases would place a patient with a prosthetic joint at risk of infection following dental treatment:

  • Immunocompromised patients- either because of disease, drug or radiation induced suppression
  • Patients who have rheumatoid arthritis or systemic lupus erythematosus
  • Insulin dependent diabetics
  • Hemophiliacs
  • Malnourished patients
  • Joint replacement patients-up until the first 2 years after joint surgery
  • Joint replacement patients-if there has been a previous prosthetic joint infection

The advisory also stratified the incidence of bacterial infections developing based upon the severity of the dental treatment. The following are the types of treatments that would require antibiotic premedication. Extractions, periodontal treatments, implant placement, certain types of root canal procedures, initial placement of orthodontic bands, and a dental cleaning in a patient where much bleeding is expected to occur. Treatment that would not indicate antibiotics would include simple restorative or prosthetic dentistry, local injections, conventional root canal procedures, suture removal, orthodontic appliance removal, impressions and x-rays.

As stated before, some physicians and dentists advocate the use of antibiotic premedication for all procedures on patients with prosthetic joints. This can present a potential problem though, for the unrestrained use of antibiotics has been shown to have certain hazards. These include overgrowth of pathogenic organisms (disease causing bacteria ), secondary infections, bacterial resistance in the patient, bacterial resistance to the drug being used and allergic reactions, including potentially fatal anaphylactic reactions.

All patients preparing to undergo joint replacement should receive a complete dental examination including the taking of new x-rays to look for any infections present in the oral cavity. Even if the patient is not complaining of any problems or discomfort, a full mouth x-ray series is definitely needed, since many dormant or non-painful abscesses are found this way. The treating of any oral infection before the joint surgery is absolutely imperative to help prevent problems in the future with the prosthesis.

Every case is different, and if the treating dentist or physician has reason to think premedication is needed for a dental procedure, than after careful consideration of the guidelines, the patients health is of paramount importance.