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Antibiotics Before Dental Work for Joint Replacements

Last year I wrote an article about dental antibiotic prophylaxis, which talked about why dentists prescribe antibiotics for their patients to take before many dental procedures.

Dental Antibiotic Prophylaxis for Joint ReplacementIn that post I mentioned that anybody who has a joint replacement is supposed to get antibiotics prescribed to them before certain dental procedures.  The reason for this is that there are millions of bacteria in our mouth that may enter our bloodstream during certain dental procedures.  When an artifical joint gets infected, it normally is considered a failure.

Since antibiotics are very cheap and they can help prevent the infection of an artificial joint, it seems like a no-brainer to give antibiotics to patients before invasive dental procedures so that the catastrophic loss of an artificial joint can be avoided.

However, there really isn’t conclusive evidence that antibiotics prevent joint infections in the average healthy person.  That is why, in the American Dental Association’s original 1997 guidelines on dental antibiotic prophylaxis for joint replacements, and in the 2003 guidelines, the ADA stated, “Antibiotic prophylaxis is not routinely indicated for most dental patients with total joint replacements.”

However, a few years later, the ADA reversed its position and stated that everyone who had an artificial joint replacement needed to take antibiotics before invasive dental procedures regardless of whether or not that person was even at a high risk for developing an infection.  Those were the current guidelines when I wrote my post on dental antibiotic prophylaxis last year.  However, I also mentioned that the ADA was looking into the issue and would likely issue some new guidelines this year.

New Dental Antibiotic Prophylaxis Recommendations for Patients With Total Joint Replacements

The ADA has since turned away from its aggressive approach of recommending that everyone with a total joint replacement get antibiotics before invasive dental work.

Last year I mentioned that the ADA had formed a task force to research the literature and form new guidelines on the decision of how to give antibiotic prophylaxis to patients who had undergone total joint replacement.  The ADA has since removed the recommendation from their website that all patients with joint replacements be premedicated with antibiotics before dental work.  They have now posted the following recommendation (I bolded the main points):

Dental Antibiotic Prophylaxis for Knee Replacement
Knee Replacement

“The American Dental Association and the American Academy of Orthopedic Surgeons (AAOS) are currently in the process of developing evidence-based clinical guidelines on the topic of antibiotic prophylaxis for patients with orthopedic implants undergoing dental procedures. The ADA and AAOS do not have a joint recommendation at this time. There are differing opinions on the need for antibiotic prophylaxis. These opinions/statements are presented below to assist the dentist in making informed decisions about the prescription of antibiotics. The ADA believes that the professional goal should be consensus among the dentist and physician, which is the expressed goal being pursued in the ongoing ADA/AAOS project.”

Basically, the ADA is stating that the dentist and physician should weigh the benefits/risks to each patient and then assess how likely it is that a given patient would develop an infection in an artificial joint.  If they determine that the risk is high enough, then antibiotics should be given before invasive dental procedures.  If the risk of infection to the joint replacement is extremely low, then antibiotics before dental work probably are not needed.

Antibiotics Are No Longer Necessary for All Patients with Joint Replacements Before Dental Work

Basically, the new guidelines (or lack of guidelines) mean that not all patients with artificial joint replacements need to get premedicated with antibiotics before invasive dental work.

I think that this is a good thing.  Many times dentists had to premedicate patients when there was hardly any risk at all of infection.  In very healthy patients, this meant that dentists were prescribing tons of unnecessary antibiotics.

I do think that many dentists and physicians will continue to prescribe antibiotics because it is the “safe” thing to do legally.  Even though lots of antibiotics may not be in the patients best interest, it is the best way for physicians and dentist to cover themselves legally.  For example, a dentist might end up in court for failing to prescribe antibiotics when it was probably needed, but a dentist would likely never end up in court for unnecessarily prescribing excessive antibiotics to patients.

What Do You Think?

Do you have a joint replacement?  Do you think that antibiotics are really necessary before invasive dental work?  Do you have any questions or concerns about taking antibiotics before dental work?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!



  1. I just had a huge argument (June 03, 2011) with my Dental Hygienist who insisted that there was a new “ruling”/recommendation from the American Medical Association regarding pre-medication REQUIREMENTS before she would clean my teeth. I refused to take the antibiotics. My last hip modification was in 2007. My primary care saved the day and told her that I did not need the antibiotics. How can a patient protect herself from someone reading information from the web??

    • Hi Diane – The only guidelines that I’m aware of are the ones that I published in this post – I don’t know of anything from the AMA regarding pre-medication. If you did have a hip replacement though, it is the dental hygienist’s right to not treat you if she feels that you need the antibiotics to be safe.

      Lisa makes a good point that there is a risk of getting your hip infected. It’s good that you’re staying informed about your dental and overall health. I hope that helps. Thanks for your comment, Diane.

      • I had bilateral hip replacement in 1996 in Boston and at that time my surgeon did not have us use any antibiotics. He was ahead of his time and a firm believer in that people are getting too many antibiotics. 10 years later when I needed my revisions, the hospital had changed its policy. So I was required to use antibiotics for a 2 year period.

        And you are correct in that the AMA has not set a new ruling. In fact, there are many surgeons (superior surgeons) who believe that it is time to eliminate the 2 year rule. The only fellow patients that I ever encountered with any kind of infections were the ones who had not been careful when selecting their surgeon and the hospital. Check out their reputations. It is most important.

        • Hi Diane – Thanks for taking the time to comment and share your experience to help others who may be going through hip replacements in the future.

    • You probably should check with the orthopedic surgeon who performed your hip surgery, as the Orthopedic Association has their own set of guidelines, and he would certainly know more about your hip than would your dentist!

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  2. As a dental hygienist I can tell you that your hygienist was correct when trying to make sure you were properly premedicated before your cleaning. It simply isn’t worth the problems that can occur when a bacteremia (Large release of harmful germs) invades your bloodstream and targets your new hip. Although it has been tossed back and forth between the Academy of Orthopedics and the American Dental Academy regarding the usefulness of pre-medicating before dental procedures, the general consensus between providers seems to be “better safe than sorry”. Taking four pills routinely before a dental cleaning is a small price to pay to ensure you don’t get a debilitating infection that will cause the hip replacement to fail and for you to have further surgery. You would probably be fine if you didn’t take them, but I can’t understand why you would be willing to take such a chance, and your hygienist was simply looking out for your best interests. I once had a patient that misled me and told me she had taken the antibiotics even though she really didn’t. She ended up in the hospital with such a bad infection not only did she lose the artificial knee that had been surgically placed 3 years previously, she also lost part of the leg. All because she didn’t want to take the premedication that her orthopedic surgeon had recommended. And, it was considered “optional” because it had been more than 2 years. At the present time, the Academy of Orthopedics is reviewing these cases to maybe change the required length of time premedication is needed. I guess no matter what I will continue to recommend my patients take the antibiotics twice yearly before their cleanings. I’m not even sure how you got into an “argument” with your hygienist, as it was only in your best interest to listen to why she felt it was necessary for you to take the antibiotics. Lastly, sometimes it’s the cumulative effect of releasing these germs into the bloodstream and then the surgically placed joint replacement that causes the damage, so why even argue? I simply don’t get it.

    • Hi Lisa – Thanks for your comment! It is a tough call and most dentists at my school recommend taking the better safe than sorry approach.

      I’m interested to see what the new recommendations are when they finally come out. It seems like they’ve been working on them for quite some time! Thanks for taking the time to share your story with everyone so that they see the importance of taking those four antibiotic pills before their dental visit.

    • Not sure if this thread is even open anymore, but in case it is: Lisa, you “don’t get it”? Maybe you would “get it” if you had had c. difficile colitis from an antibiotic, as I and many thousands of others have. This superbug is proliferating, now into the community at large, among people with few or no risk factors for it who would not have contracted it years ago before it was rampant. If you do a simple Google search, you will find hundreds of hits to that effect. Of course no one would want a hip-site infection; it would be awful. But c. difficile can, and does, kill, and it also can, and does, ravage lives, leaving people virtually housebound because of incontinence. There is no reliable, accessible prevention and cure as of yet.

        • Three replacements, hip, knee and three years ago a shoulder. Given clindamycin and amoxicillin by two dentists for same dental issue. The result was Clostridium, (C-diff). After 8 months of close to death illness from this nasty disease I am better. Not perfect. Many food restrictions and not ever feeling really good. Infectious disease specialist in Boston and orthopedist claim that too many antibiotics pre- medication is over done. Lost a crown and now need tooth root excised by dental surgeon. Frightened of being compromised again. Lost a year of my life. Replacing a joint is far easier to endure than C-diff!

        • This is only half true. Yes, there is a procedure called fecal microbiotica transplant (FMT). And yes, it’s been curative for a number of people. That said, it’s not yet given routinely, and FDA is in the process of trying to crack down on so-called stool banks that facilitate the matching of patients with anonymous (albeit screened) donors. (Many people are unable to find a donor within their own circle of relatives/friends who would pass the screening; thus the essentiality of stool banks.) FMT cannot be regarded as a “cure”; many who have it still continue to have problems. And it doesn’t guarantee against recurrence of C. difficile. With each recurrence, the patient’s odds of beating it diminish.

          So the notion that dental premedication with a powerful, wide-spectrum antibiotic is now of no concern because of a supposed “cure” for C. diff is a faulty and dangerous one.

    • Thanks for your article/advice. That and the original doctor’s article make me realize that I do not want to take a chance; I’m letting my orthopedic surgeon know how I feel (knowing that he promotes taking antibiotics before dental work as mine was not the ordinary hip replacement, but took a special design because of the way the pelvic socket was fractured; he doesn’t want to have to replace that – nor do I want him to. The relief from terrible pain was such a blessing, I would dread having to go through all that again.)

      It does seem a small price to pay to avoid the horrendous infecting of the blood stream which can raise havoc with hip or knee or spine replacement parts. Or I’m sure with any metal used in healing a fractured bone like the metal that was in my femur which was shattered years ago.

      Again thanks!

  3. I’m in the UK, had bilateral hip replacement a couple of years ago. The general consensus over here, now, (by both dentists, and GPs (doctors)) seems to be that anti-biotics should not be given – except maybe for up to 6 months following the replacement op. I recently had a large tooth extraction, and enquired about having anti-biotics, only to be told (essentially) “not required”.

    Mick Armitage.

    • Hi Mick – I kind of thought that the old recommendations that we followed here were a bit of overkill. Maybe we’re just following in Europe’s footsteps! 🙂 Thanks for the information.

      I remember an article that one of my classmates shared with me that said that Americans spend nearly $1 million on antibiotics before dental work for the prevention of one joint infection. That’s a lot of antibiotics and a lot more money than the cost of a joint replacement…

      • True, BUT IF it is your joint replacement that gets targeted by an infection then you would feel and think differently about it. When in rehab for a total hip replacement, one of my roommates had had that very thing – a staff infection got into her new hip replacement and within a year she was back in the emergency room having the metal pieces to her replacement either cleaned or thrown and replaced depending on how badly infected they were. Not a fun procedure.

  4. While $1 million dollars may seem like alot for the antibiotics just 20 hip replacement revisions would wipe that out! I have had both hips replaced wihtin the past two years and I will NOT have any invasive procedures done without prophylactic antibiotics. Yes, the risk is very low of an infection, but I don’t want to be the one that has to have revision surgery due to an infection.

    • Good point, Martin. It does seem kind of like an “insurance policy” against having to pay for a new hip replacement. The one study that I did read regarding this stated that the total cost of antibiotics does end up exceeding the cost of the few revision surgeries that would have to be re-done in the unlikely event of an infection.

      • Everyone’s oral flora is different. How do I know if the antibiotic prescribe to me will cover my oral bacteria? To cover almost all of them would require about 3-5 different antibiotics to cover gram positive, gram negative, aerobes, anaeobes.
        If I get Amoxicilli* is a very old antibiotic. My primary dr. said that many bacteria is now resistant to it.

  5. I hade 2 total hip replacements one in 2010 and one in 2011. I just went to a new dentist and she insisted that I have antibiotics before my CLEANING. I have had 6 cleanings without any problems since my first replacement I was shocked. I didn’t think cleanings counted as invasive procedures. I left the office without the cleaning and now have to premedicate. Seems silly to me.

    • Hi Donna – If the dental professional believes that it’s likely that there will be some bleeding during the cleaning, then premedication with antibiotics is recommended. Interestingly, this recent study looked at infective endocarditis (heart infections) after England changed their guidelines so that antibiotics weren’t prescribed as often and found no evidence that taking antibiotics reduces infections…

      Here’s their conclusion: “Despite a 78.6% reduction in prescribing of antibiotic prophylaxis after the introduction of the NICE guideline, this study excluded any large increase in the incidence of cases of or deaths from infective endocarditis in the two years after the guideline. Although this lends support to the guideline, ongoing data monitoring is needed to confirm this, and further clinical trials should determine if antibiotic prophylaxis still has a role in protecting some patients at particularly high risk.”

      • I would be interested in seeing their research how thier data was collected and the population of the survey.
        1.What percentage of the population was used? Did the survey group represent a small part of the population or could the survey be duplicated in other regions and low income areas?

        2.Was there a significant relationship between age, dental work, economic status to the percentage of populatin who did have complications?
        3. Did the dental proceedures vary?
        4.Was data collected on the patients on their presenting oral hygiene?

        Thanks RM

        • I think the ADA needs to look again at these guidelines. I needed a root canal that led to removal of the tooth. My dentist would not give me antibiotics because of this ADA guidelines even though I told him several times I had heart valve disease and have always taken antibiotics before any surgery or during any illness. Well, you guessed it, I spent thousands of dollars and near death trying to eliminate the infection. I will refuse to see the dentist in the future that refuses to give me antibiotics. I would like to see the ADA statistics regarding this. I didn’t die but I had plenty of hospital and Dr visits that probably cost me more than dying.

          • Ok it is a no brainer, the dentist is an expert in teeth, the ortho doctor is a specialist in bones, joint replacement risks associated with them..On one hand you have the Dental association saying oh gosh no you do not need an antibiotic, your knee replacement will be just fine..HELLLO the dentist just became an expert in your joint replacement? I think not. Now we hear the talk about building up resistence to antibiotics. How many times are you going to the dentist every month? No did not think so, we go what once or twice a year so pray tell how are you going to become resistent to an antibiotic you take twice a year? I will follow my ortho doctor’s advice of 5 years, but he adds, if he had it his way for the rest of my life..Now I just read American Academy of Orthopaedic Surgeons now recommends that antibiotics be given before an invasive dental procedure no matter how long it has been since the joint replacement procedure…RIGHT ON.

            Rose Marie Van Dee RN, MSN

  6. 16th September 2011. I am in the U.K. and seem to be caught in the middle. I had Total hip replacement 8 weeks ago, and suffer with arthritus. Still only 53 years of age. My surgeon recomends tatking antibiotic before dentistry, I need a wisdom tooth extracted. Also before any bloody proceedure.

    However my dentist will not give me any as he is worried about anaphellactic shock from the antibiotic.
    by the way I am not allergic to penicillin.

    He says that antibiotic is not needed. I would like to have them as obiously I do no want my implant to fail. The thought of revisited surgery is anathema to me and for the sake of taking a few pills I cannot see the problem.
    My dentist is worried about being sued for my having taking the anitbiotic!!! I would think he would be worried about the fact that he wouldnt give me the antibiotic! Strange… Jane

  7. Hi, I had a new pt today that had a total hip replacement 10 years ago. Her previous dentist quit giving her pre-medication 5 years ago for dental tx. The pt was irritated that I even rec. antibiotics. Her physician was contacted and did rec. pre-med, however the dentist agreed with the pt that pre-med was not needed. Should this pt be pre-medicated before treatment as the current guidlines rec pre med only within the first 2 years?

  8. Hi Tom,

    Just want to thank you for publishing this blog. I have a dental appt in 2 hours and had a toe joint replacement 1 1/2 years ago…after reading this, I am going to take my 4 pills, even though sometimes it does seem like overkill—but the alternative is WAY worse! So thanks to all of you who posted (especially the dental hygienist) for reminding me of the easier road to follow! Mary

  9. As a professional nurse with a Master’s degree, I have past experience working a joint replacement unit and saw many patient’s return with infections and required surgery to take out hardward place antibiotic beads in some cases an continous infusion of antibiotics into the wound in addition to the vein. So when I had my knee replacement I took all precauctions before and after. AND, my ortho doc who has a very low infection rate not only recommends antibiotics before dental work but states if he had his way, he would have his patient’s do it for their lifetime before any dental work. IF any of you have ever had a knee replacement, just think of the pain, the time off work, the time lost from enjoying normal activities and make a choice. Should I just take a few pills before I have that root canal or should I take the chance of having bacteria lodge in my hardware. Those who say not to take evidently have not had a replacement or enjoy the pain and prehaps in their mind the glamour and attention of having surgery?

    Rose Marie P Van Dee RN, MSN

    • I am astounded by your ignorant remark that “Those who say not to take [antibiotics] evidently have not had a replacement or enjoy the pain and prehaps [sic] in their mind the glamour and attention of having surgery?” My rejoinder: Those who say take antibiotics [“just a few pills,” per your wording]) evidently have not had C. difficile colitis, a dysenteric infection that has become resistant to treatment, is hard to eradicate, and can cause permanent colon damage and even death. The least-worst scenario for C. diff: incontinence so severe that you won’t be able to leave home (if you are able to at all) without wearing an adult diaper, plus you will be stigmatized as having a “bathroom disease” that is *disgusting* and contagious to boot. You will also run the likely risk of long-duration “post-infectious IBS,” which will severely restrict your food choices for as long as it lasts, sometimes indefinitely.

      Yes, the prospect of a prosthetic-site infection is harrowing. But putting it in perspective, the chances of that happening due to a dental cleaning, due to release of the identical bacteria released EVERY DAY via flossing and toothbrushing — would you recommend premedication before each toothbrushing? (of course not) — is INFINITESMAL, whereas the chance of contracting C. difficile colitis is rather high, and the latter risk mounts with each successive dose of antibiotics, as these meds are of the wide-spectrum (i.e., most potent) type and their cumulative effect factors into C. diff.

  10. I had bilateral knee replacement done 6 mo ago. I was referred to the Endodontist by my Dentist for a root canal because I have aquired a hard lump in my gums right above the tooth he just put a large filling on. My Dentist said it was now and absess that will require a root canal and he prescribed 10 days of Penicillin to help with the pain of the absess. It hasn’t helped the pain at all but since I was on the Penicillin I didn’t take the usual Amoxicillin and hour before a dental procedure. Today I go to the endodontist appt. He tells me antibiotics for the absess won’t help, antibiotics after knee replacement isn’t necessary and the lump isn’t an absess so I don’t need a root canal. Huh? He said the exact opposite of everything my Dentist did and they are in the same office. I’m confused, don’t know what or who to believe and I’m still in pain. I wish all the Orthopedic Dr’s and Dentist could agree on something. As for me, I will take Amoxicillin before dental work because it there is even a teeny tiny chance I would get and infection and need the my knees redone….Oh my gosh, I can’t even think of that. Besides my joint and disk degeneration I also have MS and Hypo Thyroid Disease. Yeah, I think I’m not gonna take any chances.

    • My dentist, thank goodness writes me a script for antibiotics before I come in. He is young up to date on all the new dental technology. My ortho surgeon before I had surgery found out I had a temporary crown, put a hold on my knee replacement until it was fully repaired. Yes maybe it is over kill, but having worked ortho units and seen people come back for antibiotics, hardware removal, there is only so much you can do before you end up with a metal rod holding your knee inplace, or in some cases end up without a knee or hip joint. Yes I will take antibiotics before dental work, it is your body, fight for it, you are in charge of your health care, if your health care provider or dentist have different views, state firmly, polite, you appreciate thier views but you would feel better if you recieved the antibiotics, if they still do not,,change to another provider. Do not be pushed around.

      Rose Marie Van Dee RN, MSN

    • Tami, you ARE taking a chance, whether you realize it or not, because the more antibiotics you take the more likely you are to contract c. difficile colitis, a potentially lethal and always debilitating (sometimes short-term, sometimes long-term) dysenteric superbug, the rate of which has risen astronomically in the last several years. That said, your own particular risk from not taking the premed may be greater than that from taking it. But you should not be under the misimpression that antibiotics are safe. Far from it. They are of course necessary for a procedure such as root canal. However, before cleanings and novocaine injections? I think that is where the debate is centered.

  11. Tom,

    Last week my wife had some dental work done and the dentist was insistent on her taking antibiotics prior to the procedure. His concern for infection was based on her breaking her leg in August and having devices installed. After checking with her ortho doctor she was assured she wouldn’t need anitbiotics and choose to disregard her dentists concerns and advice. This weekend we are spending it in the hospital on a IV drip with antibiotics, serious infection and pain set in quickly after the dental work. There seems to be a significant gap here in Houston between the medical and dental community on infection onset by bacteria from dental work… no one in the hospital beleaves it was caused by dental work…when we suggest it they snicker. Your blog was useful.


  12. I have been taking antibiotics prior to all dental work as I am “partial” (aargh) to the idiom: Better safe than sorry. So what I do is try to double up on any appointments that I can since I have been told that the antibiotics are in your system for up to 6 hours. I would like to know if this number is correct.


  13. I had both knees replaced in 2010 and originally was told to premedicate and also to take half of that dosage again an hour after any invasive procedures. The post medication has now been discontinued, but I certainly think continuing to premedicate is a wise choice when you consider the consequences, even though the risk may be small. I’ll continue to take my 4 pills!

  14. My 30 year old daughter had a complicated tooth extraction due to resorption. The oral surgeon refused to premedicate after my daughter asked for an antibiotic and explained that she was a poor healer. She developed an infection 3-5 days later with high fever, necrosis at the extraction site and subsequent tissue damage to the bone. I am furious that this doctors arrogance allowed this to happen. She called the doctor 2 days after the extraction reporting a foul taste in her mouth and again a parrot of a tech at the surgeons office stated the ADA does not recommend antibiotics. What happened to common sense in all this?

  15. My 86 year old mother-in- law had a partial hip replacement 7 months ago. She needs dental work but all antibiotics cause her to have diarrhea. It seems it would be safer for her not to premeditate because she runs the risk of dehydration. Plus, it makes the after math of any dental procedure miserable. What would you suggest

  16. hi my wife goes in for knee replacement in two weeks 20th of june and for the last year she has put off getting an extraction/root canal now i contacted the dentist we can have an extraction 1 week prior to surgery does this give her enough time to be on antibiotics prior to surgery or will it have to be postponed

  17. Thank you for your thoughtful review and comments. One area that does not appear well addressed are potential side effects from the use of prophylactic antibiotics. My wife had bilateral hip replacement 2 yr ago. Recently, a 2 week course of azithromycin was administered for a sinus infection. Approximately 1 month later, prior to routine tooth cleaning, 2g of amoxicillin was taken as prescribed. There were no prior problems with routine cleaning and antibiotic use. About 6 hours after taking the amoxicilling, a clear liquid-filled blister appeared on the forehead. Over the next 3 days, 7-8 of these blisters appeared, that were painful and bled when drained. These cleared in about a week when treated with neosporin. As this cleared, numerous pin-head sized pimples/acne developed on her forehead and cheeks, which lasted about a month. The dermatologist that examined this considered it a form of rosacea. but the quick onset after taking the amoxicillin and complete resolution after about 1 month would seem to be more of a reaction. My questions are: 1. Have similar reactions been reported? 2. What would be the preferred oral alternative to amoxicillin? 3. Could this have been an interaction between the azithromycin and amoxicillin? 4. Based on a relatively low weight (120lb), would a reduced amount of amoxicillin be appropriate and effective? While prophylactic antibiotic use seems prudent, there is concern about creating a similar or more severe reaction the next time dental cleaning is needed. Thanks!

  18. Now I am more confused than before i read all of these comments. i am to have my teeth cleaned day after tomorrow, and don’t know what to do. it has been 7 years since the hip replacement and the last two times i had my teeth cleaned no mention of antibiotics was mentioned. What do i do?

  19. I’ve had both of my knees replaced in 2008. My orthopedic doctor said I should take amoxicillin before going to the dentist for the rest of my life. I was surprised because I thought I only needed to do this for the first couple years after the surgery. I see the dentist 2 to 3 times a year and I’m afraid I might become amune
    to the antibiotics. I have ulcerative colitis and when I take the antibiotics, it makes the colitis worse. My gastrologist said I should tell my orthopedic doctor about my UC but the orthopedic doctor still insists I take the antibiotic. So, I really don’t know what to do. Please give me your thoughts.

  20. Lorrie,

    If you are concerned that your orthopedic surgeon might be steering you wrong with the advice to take the antibiotics for life after having both knees replaced, the best thing to do would be to speak to your regular M.D. A general practice doctor would be able to look at your entire health picture to determine, along with consulting with your orthopedic doctor of choice, the appropriate regimen for you.

    • Hi
      It depends where the Orthopedic surgeon works, because if it is a HMO, like Kaiser, all your medical records are on a electronic file. And the Orthopedic surgeon has all your records. Next I would take
      the advice of my Orthopedic surgeon that has 34 years experience as a Orthopedic surgeon over any Internal Medicine MD and especially if he or she has not had as much experience as a DR. Or any Delta Dental were some of the rulings have come from. I would go with the AAOS
      Terry A. Clyburn, MD. Better safe than sorry and you will be the one to pay with a new hip replacement not the Dentis nor the MD.

  21. The answer to this will probably not help me for tomorrow (as I go to the dentist somewhat urgently). However, I found the blog extremely helpful for many reasons.

    My concern is the risk of the antibiotics becoming ineffective in my present circumstance, or in a similar one.
    I had a cleaning on Friday and pre-medicated as usual with 3 Ciprofluoxcin (sp?). That was at 9am for a cleaning done at 10. There was no bleeding during the cleaning. But I needed fillings. The DDS was able to do one at 4pm. We are hoping the Cipro was still somewhat effective by then. (I didn’t know about following up with another pill.)
    Now I am going again on Monday because I need more fillings and must do them before I go away for a month. The carries are in the roots and evidently spread quickly there. In any event I am anxious to get them done asap. So I will be taking another 3 Cipro after a two day break.

    A few other facts. I am allergic to penicillin (thus the use of Cipro). I had a hip replacement in 2003. And I have possibly had several digestive upsets that suspiciously relate to my dental work and the Cipro. I lost 5 to 10- pounds as a result. Waiting several weeks between the cleaning and the fillings seemed to help the next time. But I never thought of the danger of the medication becoming ineffective .

    So my main concern is to understand what the risks are associated with the use of these medications losing their effectiveness esp. in this current situation. I am totally committed to the wisdom of using them but need to know how to best avoid any risks involved/ I am told I can get a test to see if I really am allergic to penicillin . My doctor recommended this as I couldn’t say what started my saying I was allergic.
    My son claims he is as well. Any comments would be appreciated.

  22. My dentist recommends that I take antibiotics prior to any dental work. I am a healthy 63 year old. I don’t mind taking the antibiotics. I would rather be safe than sorry. I don’t take unneccessary medicine. I don’t like risks either. I was found your article interesting. I was trying explain to a friend why I am required to take the antibiotics.

  23. My father is loosing the battle for his life at this very moment all due to the teeth extractions he had on 8/27/12. He is a diabetic and had a total knee replacement on 4/2/12. Neither the dentist nor the orthopedic doctor even mentioned antibiotics prior to dental work. From the time he entered the emergency room through every hospital he was taken to, I brought up the extractions, knee replacement and diabetis to everyone’s attention but it was constantly dismissed. He was treated for encephalitises (sp), west nile, rocky mountain spotted tick fever, lyme disease, herpes, syphilis – but NO ONE every gave one thought to the teeth until it was too late. He is now languishing in a VA hospital with no hope of improvement. The only thing left to do is bring him home under Hospice. I still do not understand how the all 30+ doctors involved were so ignorant to this known danger.

  24. Hi, I had a TKR a little over 2 years ago. At the time my orthopedic surgeon told me I would have to premedicate for 2 years for dental work. I was OK with that, I thought I can handle 2 years. However, now he has changed his recommendation to a lifelong premedicating regime. I am a very healthy person who normally does not take drugs of any kind. Aside from a C-Section delivery 24 years ago, this has been my only surgery and I don’t have any age related illnesses yet. I am 64 years old, exercise and watch what I eat, am very interested in nutrition and the human body.
    I am so fearful of what all these antibiotics are going to do to my immune system.
    Can you give me some guidance. When do you anticipate that a better prognosis will be given for people like me who do not want to inject antibiotics twice a year for the rest of their lives!!!!!!!!!!!

    • In my last paragraph I goofed when I said “inject” antibiotics, I meant to say “ingest” antibiotics. Just wanted to clarify.

  25. I am going to the periodontist in june to have some deep cleaning done. I have two total jont replacements for my tmj joints. I had them replaced may 2000. The periodontist office wants me to take antibiotics before i go. What do you think? I am 40 years old.

    • Hi Susan – If they recommend the antibiotics, it would be a good idea to talk with them about it. They will probably be able to answer most of your concerns and let you know why they recommend what they do. I wish I could be of more help. Let me know if you have any other questions.

  26. I had total hip a year ago and first heard of the anti biotics from a co worker.

    BIG question I have is this: Is the 4 pills considered a full cycle of anti biotics? If it isn’t then shouldn’t there be more pills over the next few days? If you don’t take a full cycle of antibiotics, then you run the risk of infection or Bacteria coming back, and in addition the bacteria becoming resistant to antibiotics. We see this to be true with all the “superbugs” due to the antibacteria infusion in almost everything these days.

    Thanks for you time.

  27. Dear Sir: I for one think antibiotics should be given before any Dental work! I had a knee replacement 6 years ago and for some reason almost all the filling came out of my teeth! The Dr. told me the dentist was going to love me! Now 6 years later still using antibiotics before dental work. I had a 2nd knee replacement and Guess what within 6 months I have already lost two filling and they took part of my tooth with them when they came out. Done pulled one and a 2nd one to be pulled soon. After my 6 month regular check up besides the 2 teeth pulled, the dentist checked some of my filling, and yes several of the other filling are coming loose, just like the last time I had a knee joint replaced! What did the DR. know that we didn’t about the link and my teeth filing and knee surgery?? Before the last knee replacement I had a regular check and had no cavities only about two weeks before the replacement! Now the are all in terrible shape just like the first knee replacement!!! Just falling out!! Thanks Lewis Baker

  28. Hi, just went to a new dentist today for evaluation of having 2 teeth pulled and when I asked him for antibiotic script to take prior to the dental work, he refused and told me to have my surgeon prescribe them for me. Needless to say HE doesn’t need my business if he doesn’t have my best interest at hand. Unforunately, my surgeon had bilateral knee replacements and I recieved a letter from him of his ‘retirement, effective immediately’. (he is 2 hrs drive away) I have not been to my family doctor for 3 yrs as I have not been sick. I was told by my hip surgeon to take antibiotics for the rest of my life before any envasive procedure. My former dentist had no problems prescribing them for me and in fact insisted I take them (glad he was on it) Anyway, I left today paying $167.00 for 2 pieces of paper (copies of the xrays) If this dentist can’t prescribe them for me….like I don’t want a hip infection; this past march I had a dislocation and that was bad enough. They are cheap & if it helps me from getting an infection, why not. Now, I am in search of a dentist who will prescribe them for me, as it is me who has to suffer if I wld get an infection, not the dentist. What was his problem? I just don’t understand it. I am almost 65 and I know my own body.

  29. […] “Antibiotics Before Dental Help Joint Replacements|Oral Solutions Taking four pills regularly prior to an oral cleaning is a tiny rateto pay to ensure you don’t acquire a debilitating infection that will inducethe hip replacement to fall short and for you to have even more surgery. Youwould possibly be great if … I have an oral appt in 2 hrs and had a.toe joint replacement 1 1/2 years ago … after reading this, I am visiting.take my 4 pills, even though in some cases it does seem like overkill– but.the choice is WAY worse! So thanks to every one of you which …” […]

  30. Hi, I had LTHR in nov last year, I’m now waiting for my 2nd this month, I have gum disease and all my teeth need sorting out, they are loose due to gum shrinkage,( not so loose that they would fall out ) but I was told put a hold on getting my teeth done till after my surgery, now it feels like my new hip after 7 months with no pain is hurting again, the physio said it’s trocantor bursitis, but after reading you post on anti biotics and possibilities of germs from the mouth getting in the bloodstream and possibly causing my new hip to fail, sorry it’s a long post , but I’m very concerned.

  31. Can someone tell me if dental caries can give you a prosthetic infection? Some studies show that almost 98% of Americans will get at least 1 in their lifetime. And most will get over 5. And if it’s true that 20%+ Americans over 80 years old lose most of their teeth due to periodontitis.
    If caries can cause prosthetic infection, then would many more Americans with prosthetic hips/knees get the infection? I read that caries are the most common illness second only to the common cold.

  32. I have had the left knee replaced twice! In short first one came loose! MY Dentist has me take Antibiotics before dental work. Now the question .When i had my first total knee replacement the DR. told me the dentist was going to really like me ! Well after the 1st knee replacement almost all the filling in my teeth came out. Now with the 2nd knee replacement the same thing almost all my filling came out sometimes 2 at a time! What did the DR. know that knee surgery was going to affect my teeth? so i am glad to take antibiotics, because of a lot of Dental work after the replacements. Thanks Lewis B

  33. I am from Los Angeles,California, I want to testify on how i got cured from HIV AIDS, I got infected with HIV AIDS disease in 2011 and I have visited several herbalists, spiritualists and pastors for cure but all to no avail, my world was gradually coming to an end until i saw a post in a health forum about a herbal spell caster from Africa who casts herbal spells to cure all kinds of deadly diseases including HIV AIDS, ALS, MND, Epilepsy, Leukemia, Asthma, Cancer, Gonorrhea etc, at first i doubted if it was real but decided to give it a try, when i contacted this herbal spell caster via his email, he prepared a herbal spell portion and sent it to me via united parcel service (UPS), when i received this herbal spell portion, he gave me step by step instructions on how to apply it, when i applied it as instructed, i was cured of this deadly disease within 7 days, I am now HIV Negative (-) all thanks to Dr.ADODO. Contact this great herbal spell caster via his Email: or call +2348156784928 Good luck.

  34. I am very happy today to share this amazing testimony on how Dr. idahosa the herbal doctor was able to cure me from my HIV Virus with his herbal medicine. I have been a HIV patient for almost 8 months now and have tried different methods of treatment to ensure that I am cured of this terrible disease, but none worked for me, so I had to leave everything to God to handle as I was a Christian who had faith that one day God would intervene in my life, yet I felt so sad and desperate as I was losing almost everything due to my illness, A few months ago while I was surfing the internet I saw different recommendation about Dr idahosa on how he have been using his herbal Medicine to treat and cure people, these people advice we contact Dr. idahosa for any problem that would help immediately, I contacted Dr idahosa and I told him how I got his contact and also about my disease, after some time Dr. idahosa told me to have faith that he would prepare for me a medication of herbal herbs, he told me I would take this medicine for a few weeks and also asked my home for home address so as possible for him to submit the drug for me, so my good friends after all the process and everything Dr idahosa actually sent me the medicine, I took it as I was directed by Dr. idahosa, after a few weeks passed, while on Dr.idahosa medication I began to experience changes in my body, I had to call my doctor at the hospital for some blood test after test my hospital doctor told me that I was no longer with the Hiv virus and my blood is pretty good, I can not even believe this, Friends well today i am Hiv Free and i want everyone to know that there is a cure for Hiv for those who will contact Dr idahosa after reading my testimony, you can kindly contact Dr. idahosa in ( or call him +2348134261542, God bless you all …

  35. After TKR my operating surgeon told me I should take antibiotics for 2 yrs following surgery. My dentist told me to take antibiotics 1 hr prior to any dental procedure and asked me if I took the antibiotic 1 hour prior to coming in. I had a colonoscopy and they gave me an iv antibiotic. The moral of the story is all of my doctors and dental people told me to take the antibiotic. It is nice to know that all of my dr’s and dental workers are on the same page

  36. I’ve given up making sense of this. THR 14 years ago. Originally my Orthodox said “Yes, you have to pre-medicate for life with antibiotics prior to dental work” then years later he changed his mind and said it’s not longer considered necessary. Then my dentist said it was, and when they called the Drs office they said it was too. They don’t have to in most of Europe (Do they have different bacteria there? No). I get sick from antibiotics every time I take them, it’s really not practical. I have lied to the dentist and said I’ve taken them when I haven’t. I worry if I’ll be ok but then think well if I was in Europe I wouldnt even be thinking about this. Sometimes I take them, but most often I don’t because I do get sick. I’m really tired of this being an issue and wish all entities could come together and figure this out once and for all.


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