In past years standard protocol has included antibiotic prophylaxis for all patients with hip or joint replacements. Antibiotic prophylaxis refers to the ingestion of an antibiotic one hour before a dental procedure to combat an expected bacteremia in the bloodstream as a result of dental treatment. In other words, when a patient undergoes a dental procedure in which bleeding occurs, bacteria from the mouth is introduced into the bloodstream. This bacteria then circulates throughout the entire body via the circulatory system, including joints where a patient has had a prosthesis placed, such as a hip replacement. The bacteria can deposit and colonize on the prosthesis, resulting in bacterial infection, and complication, of the joint replacement.

In an effort to avoid this complication, an antibiotic is ingested before the dental appointment, introducing it into the bloodstream to combat the bacteria introduced through the mouth. The antibiotic reduces the amount of bacteria in the bloodstream, thereby reducing the risk of joint prosthesis infection. Until 2009, the protocols included necessary prophylaxis for those joint replacements less than 2 years old. Although some controversy surrounds this topic, recent AAOS (American Academy of Orthopaedic Surgeons) publications have recommended prophylaxis for life in patients with joint prostheses. However, in 2012, the American Dental Association and the American Academy of Orthopaedic Surgeons (AAOS) released the first co-developed evidence-based guideline on the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures essentially claiming a lack of evidence to support prophylaxis in patients with joint replacements for dental procedures.

At O’Malley Dental, a patient’s orthopedic surgeon is always consulted and their recommendation documented and followed.