Premedicate Or Not To Premedicate

Author: Dr. Sarah Mischo, DMD

Dr. Andrew from {PRACTICE_NAME}To premedicate or not to premedicate..that is the question?

As the general population is living longer, more and more people are receiving prosthetic joint replacement procedures. According to the Journal of American Dental Association (JADA) there are more than 7 million Americans living with a prosthetic joint. One complication of joint replacement is the risk of prosthetic joint infections, which can be a serious, and even life-threatening problem. Historically, dentists have sometimes used antibiotics prior to dental treatment in patients with joint infections to try to reduce this risk. But dentists and orthopedic surgeons often disagree about whether or not these prophylactic antibiotics are necessary or useful to reduce the risk of prosthetic joint infections. So what’s the right answer, should patients who have received a prosthetic joint premedicate prior to invasive dental procedures? Unfortunately the answer isn’t simple.

While long-standing practice for many orthopedic surgeons has been to recommend antibiotic prophylaxis prior to invasive dental procedures for patients with prosthetic joints, there has never been good evidence linking dental procedures to prosthetic joint infections, and more recent studies have suggested that there likely is not any link between dental procedures and a risk of prosthetic joint infections at all. Most recently, a large, retrospective study from Great Britain looked at the dental and medical records of over 9,000 patients with prosthetic joint infections and found that they did not have an increased likelihood of dental procedures in the three months prior to the infection, suggesting that dental procedures probably did not contribute to their prosthetic joint infections. On the other hand, there is growing evidence about the consequences of unneeded antibiotics, from simple, individual problems like stomach upset, diarrhea, and allergic reactions to major crises like the increasing prevalence of antibiotic-resistant infections.

So, how are dentists (and patients) supposed to balance these factors? Currently, the American Dental Association (ADA) recommends against antibiotic prophylaxis for most people with joint replacements, unless they have another reason to receive antibiotics, although this is a discussion that should occur between you, your dentist, and your orthopedic surgeon. So, next time you’re in the office, please let us know if you have an artificial joint, and we can talk through these questions together!