Prevention and Management of Infections from Dental Procedures:

Total Joint Replacements: - Need for Future Prophylactic Antibiotics

      - American Dental Association
      - AAOS Advisory Statement: Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements
      - indication for prophylactic antibiotics for total joint patients undergoing dental and endoscopic procedures have been debated in the litterature;
      - despite the body of evidence which suggests that prophylactic antibiotics are not mandatory,  most orthopaedic surgeons can point to at least one or two cases in which a joint became infected following a late dental or endoscopic procedure;
      - noting this information, it seems reasonable that all patients undergoing significant dental or endoscopic procedures should receive prophylactic antibiotics;
      - infecting organisms: (from most frequent to least frequent)
             - staph aureus, staph epidermidis, pseudomonas, and beta hemolytic streptococci;
             - common infecting organisms include Streptococcus viridans and Peptostreptococcus;
                       - in the study by Laporte DM, et al, JBJS Vol 81 Jan 1999, the authors felt that the incidence of infections associated with dental procedures in underestimated and may account for as many as 6% of all total joint infections;
                       - reference:
                                    - Late infection after total hip replacement, caused by an oral organism after dental manipulation. A case report. 

     - suggested protocol:
             - consider tailoring the antibiotic to the type of invasive procedure;
             - dental - oropharyngeal procedures:
                      - transient bacteremia associated with dental manipulation persists for 10 to 30 minutes;
                      - oral microbial flora are usually streptococcal (peptostreptococcus) in nature;
             - antibiotic choices:
                      - 3.0 gm of amoxicillin 1 hour before and 1.5 gm 6 hours after the initial dose;
                      - alternatively give 500 mg of Keflex;
                      - if patient is pen allergic, erythromycin may be given,1 g 1 hour before dental treatment and 500 mg 6 hours after the first dose;
                      - as an alternative, the patient can receive clindamycin 


- Treatment of the septic hip with total hip arthroplasty. 
- Metachronous Infections in Patients Who Have Had More Than One Total Joint Arthroplasty.
- Delayed postbacteremic prosthetic joint infection.
- Late infections of total joint prostheses. A review and recommendations for prevention.




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, January 18, 2013 4:10 pm