Dr. Mont

I like antibiotics for up to two years after any joint
replacement. After two years only for procedures
that lead to blood like endodontic surgery. This
is also a controversial topic. We wrote two
papers on this topic and only found possible
dental related infections in patients that had
oral procedures that were greater than 1 hour
with blood loss that did not get antibiotics.
The problem is that sometimes patients don’t
know what they are getting from their dentist

Dr. David:

My wife and I are general
dentists in Buffalo, NY, with a busy private
practice; also, she is a part time clinical
instructor at the U. of Buffalo Dental School,
and I am dental director for an HMO and I also
do defense work for area attorneys who defend
dental malpractice lawsuits.

We just attended a lecture given by a prominent
oral medicine professor
which covered this topic.

I also should mention I had my right hip
resurfaced in June, 2005 (with
great success).

It has (until this April) been recommended that
antibiotics be taken prior
to dental or other medical procedures that could
cause a bacteremia (bacteria in the blood
stream) to occur, if that person had prolapsed
mitral heart valves or other valve defects of
the heart, and also for joint replacement
patients. The belief was that the bacteria in
the blood stream could settle at the site of the
joint replacement or the heart defect and cause
havoc.

This April, the American Heart Association, in
conjunction with the American Dental
Association, issued new guidelines regarding
antibiotic premedication for HEART issues only.
The new recommendation is that only certain very
high risk types should premedicate- primarily,
those with heart valve transplants, and those
with a history of having had a previous heart
infection (bacterial endocarditis). Millions of
people with less serious heart murmurs and other
issues are now advised they no longer should
premedicate. The reason is that it has been
determined that there were large numbers of
people that had adverse reactions to the
antibiotic, and very few who actually benefited
from taking it.(Exactly how this was determined
I don’t know, but it has been studied for > 25
years and this policy change was not taken
lightly.)

No changes, however, have been issued as regards
joint replacements;
however, the lecturer we heard (he teaches at
Upstate Medical Center, a SUNY Medical school,
in Syracuse, NY) told us that the research
regarding joint replacements has given the same
result- that the possible risk of taking an
antibiotic and having an adverse reaction is
greater than the possible benefit of taking it.

At this time, however, I know of no orthopedic
surgeons who have stopped recommending
antibiotics for joint replacement patients about
to have dental work. The primary reason is
probably medical/legal.

The current antibiotic recommendations for those
with heart valve
replacements, etc., and for joint replacement
patients is:

2 grams of amoxicillin (e.g.- four 500 mg
capsules = 2.0 grams) one hour
prior to the dental procedure.

If allergic to penicillin or amoxicillin:

600 mg of clindamycin, one hour prior to dental
work.

David W, DDS, Buffalo, NY
R Biomet Phillips 6-05