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Old 01-02-2020, 11:29 AM
 
746 posts, read 407,536 times
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I have experienced varying guidance on whether or not to take an antibiotic an hour prior to any dental procedure after any joint replacement. Even the 3 Ortho surgeons that I interviewed prior to my TKR all said different things.

My surgeon said I must take 2 antibiotic pills prior to any dental work for the rest of my life. Another said only for the first 2 years, then none after that. A third said it was not necessary to take an AB prior to dental work.

I've read that the Canadian and American Dental Associations have dropped condoning antibiotic prophylaxis for dental work following joint replacements, but Ortho surgeons generally don't agree, so there is now a conflict of advice from the two professional organizations that is very confusing for the patient. My dentist was neutral on the topic and said he'd do whatever I prefer (indicating to me that he doesn't personally feel it's necessary). I decided on the conservative path and will follow my surgeon's protocol for antibiotic prophylaxis prior to getting my teeth cleaned next month. This will be the first dental work I've had done since my TKR 8 months ago and am kind of nervous. I wonder if taking the antibiotic practically guarantees no joint infection?

For instance, a friend's husband has had 2 TKRs by the same surgeon and she claims the surgeon never told them to do anything special with dental appointments and he's had many in the years since his replacements with no problems. I was shocked that she never heard of this!

So I'd really like to hear from those that have had joint replacements - do you follow this protocol of antibiotic prophylaxis prior to dental work? And if so, are you doing it for a limited time (like just in the first 2 years), or do you plan to do it for the rest of your life? Any out there that have never taken AB's prior to dental work, nor plan to do it in the future, with no resulting issues.

Last question - have you or anyone you know ever gotten an infection due to dental work following their joint replacement, whether antibiotic prophylaxis was practiced or not? I'm trying to get a sense of how common contracting an infection from dental work is.

Research on the internet has been very confusing and conflicting, so I'd like to hear some personal experiences of people on this forum. Thanks!

Last edited by BijouBaby; 01-02-2020 at 11:40 AM..
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Old 01-02-2020, 11:44 AM
 
Location: Coastal Georgia
38,532 posts, read 47,419,225 times
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Quote:
Originally Posted by BijouBaby View Post
I have experienced varying guidance on whether or not to take an antibiotic an hour prior to any dental procedure after any joint replacement. Even the 3 Ortho surgeons that I interviewed prior to my TKR all said different things.

My surgeon said I must take an antibiotic prior to any dental work for the rest of my life. Another said only for the first 2 years, then none after that. A third said it was not necessary to take an AB prior to dental work.

I've read that the Canadian and American Dental Associations have dropped condoning antibiotic prophylaxis for dental work following joint replacements, but Ortho surgeons generally don't agree, so there is now a conflict of advice from the two professional organizations that is very confusing for the patient. My dentist was neutral on the topic and said he'd do whatever I prefer (indicating to me that he doesn't personally feel it's necessary). I decided on the conservative path and will follow my surgeon's protocol for antibiotic prophylaxis prior to getting my teeth cleaned next month. This will be the first dental work I've had done since my TKR 8 months ago and am kind of nervous. I wonder if taking the antibiotic practically guarantees no joint infection?

So I'd really like to hear from those that have had joint replacements - do you follow this protocol of antibiotic prophylaxis prior to dental work? And if so, are you doing it for a limited time (like just in the first 2 years), or do you plan to do it for the rest of your life? Any out there that have never taken AB's prior to dental work, nor plan to do it in the future.

Last question - have you or anyone you know ever gotten an infection due to dental work following their joint replacement, whether you practiced the antibiotic prophylaxis or not? I'm trying to get a sense of how common contracting an infection from dental work is.

Research on the internet has been very confusing and conflicting, so I'd like to hear some personal experiences of people on this forum. Thanks!
I have had both knees replaced in the past 16 months. I take the antibiotic at the dentist to be on the safe side.

I have not heard of anyone having an infection from dental work after joint replacement, but I know a woman who died after breaking a bone from a fall, because bacteria from her recent dental work settled in her heart and killed her. Furthermore, my husband got a very serious infection a year after a hip replacement. It was probably not related to any dental work, but if one can get an infection at the site after a year, I think it’s further reason to err on the side of caution.

My question about the 1x antibiotic is, I thought a person had to take an antibiotic for a certain length of time, so as not to “train” the bacteria to become immune to it.

I will probably be comfortable discontinuing the pills at the dentist after 2 years, but I’m going to check back with my ortho doc first.
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Old 01-02-2020, 11:53 AM
 
Location: Herndon, VA
2,176 posts, read 2,280,629 times
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You've gotten various guidance, because there are differing opinions on the subject. No one here is going to be able to give you any clearer guidance leaning on their anecdotal experience than what you've already gotten. Do what you think is best for you.

In my case, I ask for them at the dentist office before procedures. I've been doing this since 30 years old after an ACL reconstruction. It seems a pretty safe way to navigate the situation with little chance of side effects.
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Old 01-02-2020, 11:56 AM
 
746 posts, read 407,536 times
Reputation: 2789
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Originally Posted by gentlearts View Post
I have had both knees replaced in the past 16 months. I take the antibiotic at the dentist to be on the safe side.

I have not heard of anyone having an infection from dental work after joint replacement, but I know a woman who died after breaking a bone from a fall, because bacteria from her recent dental work settled in her heart and killed her. Furthermore, my husband got a very serious infection a year after a hip replacement. It was probably not related to any dental work, but if one can get an infection at the site after a year, I think it’s further reason to err on the side of caution.

My question about the 1x antibiotic is, I thought a person had to take an antibiotic for a certain length of time, so as not to “train” the bacteria to become immune to it.

I will probably be comfortable discontinuing the pills at the dentist after 2 years, but I’m going to check back with my ortho doc first.
Yes, my mother had to take antibiotics at dental appointments for years due to her heart. Years later though when she moved, her new heart doctor told her this practice is not necessary and she could stop (which she did). So, go figure....
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Old 01-02-2020, 11:58 AM
 
746 posts, read 407,536 times
Reputation: 2789
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Originally Posted by Robert20170 View Post
You've gotten various guidance, because there are differing opinions on the subject. No one here is going to be able to give you any clearer guidance leaning on their anecdotal experience than what you've already gotten. Do what you think is best for you.
Hey, I'm not asking for guidance, I'm asking for personal experiences, which I have heard practically none of. Big diff! I got plenty of guidance - but mostly conflicting. (but thanks for your experience.)

Last edited by BijouBaby; 01-02-2020 at 12:08 PM..
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Old 01-02-2020, 12:07 PM
 
746 posts, read 407,536 times
Reputation: 2789
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Originally Posted by gentlearts View Post
... Furthermore, my husband got a very serious infection a year after a hip replacement. It was probably not related to any dental work, but if one can get an infection at the site after a year, I think it’s further reason to err on the side of caution.
Do you have any idea why your husband contracted an infection a year after his THR (if I may ask)? It's scary to know that you can contract an infection any time for the rest of your life following a joint replacement. Makes me super paranoid of getting any cuts or scrapes.
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Old 01-02-2020, 02:35 PM
 
Location: on the wind
8,924 posts, read 3,902,858 times
Reputation: 30342
Quote:
Originally Posted by Robert20170 View Post
You've gotten various guidance, because there are differing opinions on the subject. No one here is going to be able to give you any clearer guidance leaning on their anecdotal experience than what you've already gotten. Do what you think is best for you.

In my case, I ask for them at the dentist office before procedures. I've been doing this since 30 years old after an ACL reconstruction. It seems a pretty safe way to navigate the situation with little chance of side effects.
Not to mention that any one individual's tendency to get infections is just that...individual. That may have nothing to do with dental work or joint surgeries. People can be more or less immunocompromised at any time for lots of reasons. Anecdotes are just that...and of limited value applied to anyone else.

FWIW, I had a THR over 20 years ago. I recall being advised to do antibiotic prophylaxsis for dental work for about 5 years afterwards. That was guidance from one respected surgeon at that time. Remember, 20 years ago. I didn't have any dental work done other than basic cleanings during those 5 years, didn't do any antibiotic prophylaxis after the first year or so, and never ended up with any joint infections. But then, I've never had any joint infections to this day either...and the 5 year "prophylaxis recommendation" expired 15 years ago. It proves nothing either way.

Just 4 weeks ago I had a heart attack and I have also had some dental work since. The dentist was the one recommending antibiotic prophylaxis this time. I'm listening. A single dose of antibiotics (which is the current guideline to deal with the flush of bacteria "liberated" by the dental procedure) isn't going to hurt anyone and just might save a lot more than a joint.

An article that might be worth reading:

https://sciencebasedmedicine.org/ant...al-procedures/

Last edited by Parnassia; 01-02-2020 at 03:00 PM..
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Old 01-02-2020, 02:37 PM
 
Location: on the wind
8,924 posts, read 3,902,858 times
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Originally Posted by BijouBaby View Post
Do you have any idea why your husband contracted an infection a year after his THR (if I may ask)? It's scary to know that you can contract an infection any time for the rest of your life following a joint replacement. Makes me super paranoid of getting any cuts or scrapes.
If you are worried about it, work to keep your immune system healthy.
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Old 01-02-2020, 02:48 PM
 
746 posts, read 407,536 times
Reputation: 2789
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Originally Posted by Parnassia View Post
If you are worried about it, work to keep your immune system healthy.
Yes, I realize this is key and am working on that.
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Old 01-02-2020, 03:30 PM
 
Location: Coastal Georgia
38,532 posts, read 47,419,225 times
Reputation: 65178
Quote:
Originally Posted by BijouBaby View Post
Do you have any idea why your husband contracted an infection a year after his THR (if I may ask)? It's scary to know that you can contract an infection any time for the rest of your life following a joint replacement. Makes me super paranoid of getting any cuts or scrapes.
A theory was that it had something to do with a colonoscopy he had a few months after the hip replacement. The infection was a type of E. coli, but they dont know for sure how it wound up in his hip. He had to wear an IV and a penicillin pump for 6 weeks. Not fun. Thankfully, it worked.
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