Do You Need Antibiotics Before Dental Work If You Have A Joint Replacement?
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- Опубликовано: 31 май 2024
- In this episode of "Talking with Docs," our medical experts delve into the topic of antibiotics before joint replacement surgery, specifically focusing on the precautions related to dental work. Join us as we discuss the rationale behind prescribing antibiotics, the potential risks of infections, and the ongoing debates within the medical community regarding this practice. Gain valuable insights and expert advice to better understand how dental procedures can impact joint replacements and the importance of following personalized healthcare recommendations. Don't miss out on this informative discussion that can help you make informed decisions about your dental and orthopedic health!
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I am a retired dentist of 40 plus years, and generally agree with you. This topic has been kicked back and forth between the Orthopedic and Dental Community for many decades. When I left practice several years ago, we would premedicate for the first two years post orthopedic surgery. Afterwards, it would depend on several factors as you have said. As a dentist, I don't think patients and even physicians realize how bloody our procedures are. (we hide it with high speed suction) But sometimes procedures are not bloody at all. All this needs to be considered by the dentist and orthopedic surgeon as to what is best for a particular patient. In any case, maintaining healthy teeth and gums is of utmost importance!
I have a bioprosthetic heart valve. Since getting that implant, my dentist requires me to premeditate before a cleaning.
This was the most amiable, well-reasoned non answer I've heard in some time.😅
Agree with what? The fact that orthopedic surgeons have ignored that there is NO!!! clinical evidence that taking antibiotics reduces the risk of infection after joint surgery? I practiced dentistry for 40 years and always felt that it was an unnecessary procedure that the orthopedic docs did, even after the American Dental Association reviewed all of the data and found nothing to support premedication for routine joint replacement. Also, if the orthopedic surgeon leaves it up to the patient to decide if they want to go ahead and take antibiotics, the physician that did the joint replacement should provide the Rx, not the dentist, hey we’re busy too! I can’t believe that it took so long for the orthopedic group to realize that what they were so adamant about, had no clinical support in any reputable studies here to date.
Dear Esteemed and Venerable Dentists,
What would you say to the patient who has bad gingivitis and is on 3-month recall?
I'm asking for a friend, of course. Lol!
That's great!
So, what about when your SO poor (financially) and TERRIFIED because of PAST dental trauma, huh?
As a retired dental hygienist of over 40 years I always appreciated the orthopedic surgeon who provided their patient with this information ahead of time.
Interesting topic! Since my knee replacement surgery in 2018 I have been prescribed antibiotics before a prophylaxis. I have since had back surgery and still take an antibiotic before a prophy. I feel more confident taking the antibiotic.
My dentist gives me Clindamycin before every cleaning and an extraction 4 months ago (18 months since hip replacement). I trust him. I’m 76 and don’t want to die from an infection that could so easily be prevented.
Why are you taking Clindamycin? Clindamycin is a terrible antibiotic, worse for your gut than Amoxicillin.
Having 2 hip infections with 4 replacements, I always take antibiotics before any procedure
I practiced dentistry for 40 years ( recently retired) and never felt comfortable premedicating patients for joint replacements. I also feel that if the orthopedic surgeon insists on it, then they should be responsible for writing the Rx. The ADA has been against premedication on all joint replacements for several years. The cardio group also relaxed their protocol on certain heart conditions quite awhile back. Glad to see you guys finally saw the light.
Had a hip replacement in 2018. Don't take them. Have had extractions with no problems. Actually, I have had more problems with amtibiotics, so for me, I will not take them. I guess everyone will have to make their own decision.
My dad died from bacterial endocarditis following a standard dental cleaning even though he took prophylactic antibiotics. He picked up P. acnes which is a slow growing organism. His cardiologist missed the diagnosis. His internist missed the diagnosis. A PA missed the diagnosis. A nurse missed a dvt caused by the bacteria biofilm growing on his heart valve (a replacement of biological origin) causing clotting.
He was very sick, kept notes, tried to get care, but ran into incompetent practitioners who missed ALL the signs and went to the ER far too late. Even at an excellent hospital, it took ten days to identify the bacteria and by then the infection was absolutely raging. They tried to operate to replace the valve and it was a mess. He never recovered and died the die after surgery.
Any prophylactic antibiotic course needs to be long enough to counter slow growing infections.
His was not a joint replacement. I would argue strongly that any heart prosthetic recipient should have a full antibiotic course with dental care. His valve was damaged by rheumatic fever as a child.
I had a hip replacement 14 years ago. My surgeon still suggests prophylactic antibiotics; my dentist does not. I went with my dentist and no issues.
I am retired dentist and practiced before premedication for joint replacement was standard. Guidlines have changed over years. I would suggest at a mininmum, a preoperative dental exam should expose and resolve any chronic or acute infection prior to surgery. I would further suggest if there is any doubt as to necessity to premedicate, to take the one dose as the risks taking this are minimal. I agree this decision should be applied on case by case patient input.
Well it happened to me & I was septic After 4 units of blood transfused, a surgeon removed the old hardware(hip) & gave me a new one after debridement. That hip also became infected after just a couple of weeks. The pain was INTENSE! I was treated by infectious disease docs who put me on 3 IV antibiotics, including vancomycin for 12 weeks (picc line) I was on antibiotics for a total of 15 weeks before they concluded that the bacteria had formed a biofilm on the hip components and needed to come out. So I had another hip replacement. Then another 8 weeks of antibiotics (all were via picc line or IV. I feel that I’m fortunate to receive care in Boston with the superb hospitals there, I live just south of Boston. That mess was in 2017-2019. Then my other hip became very painful due to arthritis from a fracture. While in a nursing home recovering from the first replacement hip, I was left alone on the toilet & told to use the wheelchair to stand up. Well, the brakes didn’t work so I went flying and ended up falling on my Fanny onto the cold, hard bathroom tile, breaking my hip. Nobody noticed & nobody thought to xray. I also broke my fibula which also was left to heal on its own. From that day I was in agony! The arthritis finally got bad enough that the orthopedics at MGH/BRIGHAM & WOMEN agreed to do a total hip replacement. I did get a superficial infection which was pretty bad…a lot of swelling, redness & pus. Honestly, I phoned the home health agency & ordered a nurse (I was getting home OT after the THR) Someone showed up within the hour!! I took daily photos of the leg which I sent to my doc via the patient gateway so my infection would be documented and also for the doc to keep an eye on the infection. I was treated with the new formula of bactrim twice..2 rounds. I also drained the very large swelling with the help of the visiting nurse. That did a lot to relieve the pressure & some pain. I’ve honestly NEVER seen so much pus & blood! Disgusting yet fascinating. lol. Did what I could with keeping the area clean until it healed which took 10 weeks. They didn’t want to do a needle aspiration to test the synovial fluid as I asked for (I was scared of a bigger infection) and blood markers for inflammation were not too off, so I just continued to treat this superficial infection. I had this last hip replacement on January 12 and finally, last week, I was able to go out for a 1/2 mile walk! First time since 2016!!! My future/lifelong protocol is 2000 mg of amoxicillin prophylactic for any oral work. Thanks for your show guys!! I love it. Sincerely, Michelle in Randolph,mMA
Oh, Michelle, that sounds horrible!! I hope you are able to stay infection free. I had a knee replaced in 2018 and my surgeon has me taking Clindamycin prior to any dental work or cleaning.
You've been thru the whole gamut, you poor thing. I hope you continue to improve, both in health and in your ambulation, and catch up for all your lost time.
What a nightmare. Your neighbor in Rhode Island
I’m so sorry you had to go through all that! I’m facing a hip replacement revision soon due to the surgeon putting in too big an acetabular cup. The pain is severe lifting my leg since the surgery 18 months ago. That’s is scary enough. Hope you continue to improve.
Timely advice, gentlemen. Thanks as always.
I had infection complications after my TKR and was prescribed antibiotics for life prior to any dental procedure.
In general conversation , I just happened to mention that I’d just had a knee replacement and suddenly my dentist stopped what she was doing, (she was getting things ready to extract a tooth) and it seemed that everyone in the dental surgery went into a state of panic. A phone call to my surgeon who said yes, I needed five antibiotic tablets one hour before any dental treatment for the rest of my life! So I was sent away with a prescription for the antibiotics and had to return on another day. It would have been helpful if my knee surgeon had told me this beforehand. I have since been diagnosed with rheumatoid arthritis, an autoimmune disease, so that is another reason I must have antibiotics before dental appointments.
Just me here, once I found out that I had any autoimmune disease, I would be researching it religiously. I would be so invested in knowing about my own condition and not just leaving every decision up to any doctor.
This debate wouldn't be a surprise to me and I would know that again, weighing risks & benefits with knowledge of my own vulnerability to illness with my autoimmune disease would inform me that antibiotics would be beneficial.
I don't leave my healthcare up to just my doctors anymore. Too many don't listen or follow up like they should. Trust is a two-way street.
Love your informative videos , thank you .
Something to consider is over prescription of antibiotics. Would be nice to see a meta analysis of all recent studies on dental work following total joint replacement.
Thank you for this informative video.
Such an important topic! My husband will be so happy to hear that it’s up to him.
Love this channel. Helped me so much before and after my knee replacement in March. Thanks
This is very interesting
I’m happy you enlighten people about this
After my knee replacement, my dentist and my ortho had several conferences because I am allergic to 10 antibiotics, including clindamycin, the dentists’ antibiotic of choice. They decided just to give me nothing before dental care, and four and a half years later, I have had no problems. Glad to know that this practice is no longer written in stone since I really had no choice but to not take anything.
I had a dental cleaning 3 months after my knee replacement. When I called my surgeon to see if I needed an antibiotic he was the one who prescribed it but at my appointment the hygienist said it wasn’t really necessary. I’m glad I took it though. It was only one pill, not a long course , so I didn’t have the side effects I’ve experienced with antibiotics in the past - and it gave me peace of mind.
Hi Docs 706k! Congrats! And a great topic! I had a root canal and crown 4 weeks after my knee replacement. Surgeon and Dentist agreed no antibiotics were needed. I’m healthy. Too many “superbugs” because of the overuse of antibiotics out there. 🦠
As a dentist, the issue that has been pointed out by others in the comments is that the American Dental Association does not recommend prescribing prophylactic antibiotics for most patients with joint replacements as of 2015, so in terms of the dentist writing the prescription there's a bit of a conflict there. Now have I written scripts for patients who request it on a case-by-case basis? Yes, but if a surgeon feels strongly about a patient having them before every dental appointment indefinitely then they should prescribe it. As you said the evidence isn't there to support the practice and dentistry is one of the areas of healthcare that is frequently cited for overprescribing of antibiotics, so I'd rather follow the science and not contribute to that issue further.
My orthopedic surgeon who replaced my hip recommends it and my dentist of the last 30 years agrees. Its cheap insurance but to each their own.
Agreed
@TalkingWithDocs My dentist only recommends it because he actually had a patient get an infection after dental work and it went to the joint replacement site. Not sure what joint it was though.
You guys are awesome. I am coming up on a year with my new hip. You two were a big help in my decisions to get it done and my recovery. I keep watching. I am always learning from you two. Keep up the great work.
Bilateral knee replacement and hip replacement. Had a CABG also. I am always advised to take antibiotics before visiting my dentist. So far , so good!
Thank you for this info! I have hip replacements so it’s good to know.
I used to hear this about Heart valves before Joint replacements were so common.
Great video. I do take a biologic for my arthritis which lowers my immune system . Ive had hip and both knees replaced. My ortho surgeon said take antibiotics before dental work for life.
My surgeon said no dental work whatsoever for one month before surgery, and (I think t was) five months after. After that you can go to the dentist without antibiotic. This makes my dentist nervous... Thanks for always sticking to the best evidence - but sometimes it's just not conclusive.
I am not a medical professional, however my orthopedic surgeon is and he's recommended I take 4 500 mg capsules of Amoxicillin before every dental procedure, and this is for life. My dentist asks me if I've taken my antibiotics before he starts the procedure. I've had both knees replaced and see my surgeon for a 1 year follow up in a couple weeks. I'll ask him if he's changed his mind on taking antibiotics.
Had a right shoulder hemi arthroplasty 15 y ago due to biking accident. First dentist I saw after this calls the hospital (#7 orthopedic) in the US) and they tell him we don't recommend this anymore. Every dentist since then does not require this other than a general precaution and not because of the joint replacement. Antibiotics with or without joint replacement
Thank you for this video. My dentist insisted I take antibiotics. I said no and he,(well his receptionist) told me they would not treat because I had total hip replacement in 2021 and get frequent UTI's due to prostate problems.
Do you, or could you, do a video on the pros and cons of taking antibiotics?
You guys are the best channel on RUclips as far as I'm concerned. Plus you're Canadian! 🇨🇦
I had both TKR 5 months apart in 2022. My orthopedic surgeon said he goes by the ADA guidelines, which now say antibiotics prior to dental work or cleaning is not necessary. My dentist feels it is necessary. So I went to my general physician. She agrees with the ADA, saying there’s no evidence to support me needing antibiotics prior to dentist appointments. My dentist informs me every single time that he feels I need them. It’s such a quandary..
If you are otherwise healthy, have no autoimmune diseases, I would following no antibiotics routine. Healthy diet, good sleep, regular exercise is more sound than theory or fear.
I agree with letting the patient decide. My ortho wants me to take them for every dental appointment (I had a THR), my dentist said to follow my ortho’s direction, but I said NO. I had so many antibiotics for recurrent UTIs over the course of almost two years that they contributed (I think) to my gut issues. So when I told my dental hygienist that I wasn’t taking them, she checked with the dentist, the dentist checked my medical records and she gave the OK to go ahead without antibiotics.
Hubby had hip replacement on Jan 23rd this year. He had teeth cleaning on Apr 30th. Nothing was said to him about medication by his surgeon and hubby didn't inform the dentist about the HR saying that he didn't have any health changes since his last appointmemt. 🙄 So far, he's been ok. You're bang on, you are responsible for your own health. Men! 😅
Female bigot ! Your husband is lucky to have you in his life !
My first knee replacement was in 1995. Somewhere around 2015 my dentist told me that I don't need the antibiotics any longer. I was so nervous, but let the dentist work without the antibiotics. I've never had a problem either way.
Gret video. Thanks for the resource.
Glad it was helpful!
I've been told 2 yrs and agree with the reasoning the surgeon gave me, thanks for the info, I feel better informed now
I was instructed to take it cause I have multiple joint replacements. So I did!
I also have multiple joint replacements and I had a severe knee replacement infection (Staph) discovered while I was still hospitalized post op. I took a strong dose of Doxycycline daily for 18 months post op. Now I take a pre-dental dose of 2,000 mg of Amoxicillin which I will take for the rest of my life. My only question now, after reading some of the comments, is Amoxicillin the correct oral antibiotic? 😮
Amoxicillin is the antibiotic I have always taken before dental procedures x40 years now post open heart surgery in 1967. Way back then I was given Amoxicillin by injection the day before, the day of and the day after any type of minor surgery. Then it changed to oral Amoxicillin day before, day of and day after. Now it is 500 mg - 4 capsules before any dental cleaning. Although my dentist does say no longer necessary, I still take them.
Perfect timing. I had hip replacement in January and have cleaning scheduled for next week (May). I know he wants antibiotics, so maybe I will do them this time. Great video!
This is very interesting as I'm scheduled for hip replacement in about 2 weeks. The information given to me by my surgeon says no dental procedures for 3 months after joint replacement. After 3 months any dental procedure will require antibiotics prior to treatment for at least one year. The thought of sepsis really scares me because I watched my daughter get way too close to death from sepsis. So I take the possibility of infection seriously and would rather be safe than sorry. This video came at just the right time for me. Thank you!
I had my left TKR in March 2023. I asked my surgeon if I still need to take antibiotics before dental procedures. He said I should for another year. So basically antibiotics before dental procedures for 2 years after surgery.
I just bought your merch and I am super duper excited!
They have merch? Where?
I worked as a RDA for 41 years and have seen the up and down arguments for pre dental antibiotics after joint replacement surgery. Generally the older DDS preferred to prescribe regardless of the new data while others went with what the current guidelines were. In 2017;I was diagnosed with severe RA…in 2018 I had THR that had be stop all RA meds for 3 months prior to surgery. A week after surgery I developed one of the worst bacterial infections one could imagine. A second total replacement (;all new parts.) was preformed and off to a rehab facility for IV antibiotics for 6 weeks. Moral of my story….antibiotics forever before any dental procedures. I’m orthopedic and dentist worst nightmare as a patient😂.
Thank you for this. After my shoulder replacement last summer my surgeon told me to check with my dentist before my first cleaning post-surgery. My dentist prescribed an antibiotic which I took. Several months later I went for my next scheduled cleaning and forgot to ask about the antibiotic and had the procedure without it. My dentist told me about the divergent opinions among surgeons on the subject and based on that I have since decided to forgo further prophylactic antibiotic treatments prior to visits to the dental hygienist.
Just had my first dental cleaning post posterior hip replacement five months ago 😅and my surgeon recommended antibiotics. I happily complied but I may not feel the need in a year or two. The surgery is too fresh in my mind right now and I certainly don’t want to repeat that again so taking antibiotics whether necessary or not was an easy decision.
Hi Docs,
i am a dentist and love your channel. I agree with your comments.
I had to cancel my regular 6-mo dental cleaning due to a traumatic hip fracture. Dental office wanted to reschedule in 2 months. I arrived on new date and they wanted to know why I hadn't taken my antibiotic, which the scheduler hadn't mentioned. After looking at pros and cons I decided to take it. They had me wait ten minutes in dental chair, then they followed with procedure. I was given a script for next cleaning, but I believe I'll decline after seeing your informative video. Once again, thanks you two great guys!😊
Very welcome
Thanks doctors!
Thanks for finally getting around to this one...when I close my eyes and read the scale of benefit vs. risk I'd rather be the person who doesn't have to undergo the revision. It is a tug of war between our dentist and orthopedic surgeon so we'll make a "informed, intelligent decision." As a two-person family with 3 and about to go on 4 artificial joints we'll keep taking them but will continue to monitor the discussion. Thanks docs!
After my first knee replacement in 2007, my surgeon recommended antibiotics for a year. Subsequently I had hip replacements, 2 years and 4 years afterward. Same surgeon who then said the recommendations changed to lifetime use. Now after the other knee and then both shoulders in the last 6 years, I'm still following the recommendations. My dentist prefers I do. However, all along I have wondered about antibiotic resistent bacteria. It may be time to have a serious conversation with my dentist about what you have discussed....actual proof for the need. Thank you.
I am on life time antibiotics, I was five weeks post op of a hip replacement I got an infection in two areas one on the hip that was replaced and one on the spine. When I went to the hospital they found a bacteria in my blood, after a number of months tried to come of the antibiotics and only lasted a week before going back into hospital, hence the life time antibiotics
Sorry to hear about all your health issues! 😊
Hey Brad, great video and fascinating discussion. I have been taking antibiotics ever since you did my first hip replacement 10 years ago. It has been a year and a half since my knee, I will see what my dentist says about continuing the practice but I am comfortable still taking them.
Mike
My TKR was done in 2002 and remains in good condition. I have never taken antibiotics for any dental work since then.
I'm a dental hygienist and also a joint replacement patient (both hips)! I have a suggestion: There is a saliva test that is easy, non-invasive and not terribly expensive (around $100 I think). It's called Oral-DNA and it measures the bacterial load of 10 oral pathogens - some of which are extremely pathogenic and invasive. I think that all joint replacement patients should have this test before they have their surgery and then get on a periodontal treatment and maintenance schedule. Those
I'm speculating here - but I imagine that patients who have certain types of pathogens that are over the "threshold" would be much more likely to develop an infection in their prosthetic joints and should be taking the antibiotic premedication … unlike those of us who do not have those particular pathogens.
My surgeon told me that about 1 in 200 knee replacement patients develop an infection … which seems high to me. YIKES!!
In those cases, do you culture the infection to find out what you're dealing with? If it's staph, that would suggest the origin was the surgical wound site (e.g., skin). If it was one of those periodontal pathogens mentioned above, then it suggests the oral microbiome.
One more thought - my good friend (also a dental hygienist) needed to have a revision because her knee replacement was giving her so much trouble. They discovered too late that she was allergic to one of the component metals (I think it was nickel) in the prosthesis. Everything is better now - new prosthetic knee and no nickel. Would you ever advise allergy testing before ortho surgery?
Thanks for the video!
Because of an accident, I had multiple orthopedic surgeries, including a hip replacement, at the same time as having multiple oral surgeries and dental implants. Granted, I am a very healthy 50-year-old. But I had zero problems with infection.
You guys are funny as well as informative. Good combo.
Appreciate it! Thanks
This has just become an issue for me ( hip replacement). I am in the process of getting a dental implant it will take 6 months and 10 appointments including my regular cleaning. I was not comfortable with taking antibiotics that frequently and was told by ortho it was necessary. I researched and found out what you are reiterating.
That's my exact condition(s) too. While I haven't received my tooth implant nor my HR yet, to know that this was even this level of longterm debate makes me that much more unsettled about doctors and western medicine. Yikes.
All we can do is take the best care of ourselves with healthy diet, sleep and exercise--antibiotics or not.
My dentist had me do antibiotics for the first year after my knee replacement.
Awesome as always my favourite Docs!❤ Anti dentites!
The orthopods I work with say if you're having somthing invasive done. Also no dental anything 6 weeks before or after your total joint replacement.
My surgeon advises me to take antibiotics before every dental procedure because I have chronic lymphocytic leukemia and am immune compromised due to that. I also have low immunoglobulins with very low IgA and no detectable IgM. Those are the reasons my surgeon gave me for taking antibiotics before every dental procedure and any other procedure that involves penetrating the skin (except shots).
I had a hip replacement 4 years ago and my ortho surgeon still calls in the prescription not my dentist. I've always been worried about taking antibiotics every 6 months and even after watching your video I'm still worried. Also, I had no idea antibiotics would become routine in my life until after the surgery and was very upset when I did find out.
There's a lot of guilt by doctors that antibiotics are over prescribed but don't mention that 80%of antibiotic use is for food additive to animal feed in order to keep them healthy and fat. Antibiotic resistance is largely caused by this. The downside is so great (infection of a replaced joint requiring a revision) that this use of an antibiotic is a no brainer. Four Amoxicillin 500 mg capsules an hour before your visit is a lot different than a 10 day course. 🥸
I love you guys!!!!
Had hip replacement in 2012. Dentist said ask surgeon and he said whatever dentist said. Took before cleanings for 2 years and stopped. New dentist in 2015 and he said do it forever. Moved again in 2020 and new dentist said not needed. TKR last November and this surgeon said only for the first 6 months. I do have penicillin allergy so I have limited options
I have 2 total knee replacements and every time I went to the dentist for cleaning or other minor procedures, I was prescribed amoxicylin.
Had a hip replacmente in 2003........yes.....2003 and my orthopedic surgeon still insists on me taking 2000 mg of Amoxicillin 1 hour prior to any dental procedure that produces ANY type of bleeding. I take it because I don't know whether I should or should not......so better safe than sorry. The Amoxicillin does not cause me any side effects and it only happens 2x year at each cleaning. I am 70 and certainly don't want to catch an infection this late in life which will incapacitate me for any length of time.
Great video guys. Last year I had infective endocarditis ( likely caused by dental procedure ) - mitral valve needed replaced after 6 weeks of IV antibiotics. Please can you do a video on endocarditis with your cardiac surgeon buddy :-) Thanks from Scotland !
My dentist and surgeon both say I need to pre-med with two tablets of clindamycin one hour before I see the dentist for a cleaning, procedure or anything where bleeding might be involved for five years. It’s the same way with the dermatologist or when I got a colonoscopy.
Not really on this topic but a discussion of catheters use, kinds, dangers etc. would be great….an extremely common medical device procedure that often leads to secondary issues that could easily be avoided but giving patients clear instructions for their use particularly out of hospital.
I have 2 pins in my right shoulder to mend a torn Supraspinateous tendon. I never have taken antibiotics before any dental work including replacing crowns and cleanings. Never had any problems.
My TKA (left knee) was on 12/6/23, have no other implants, and my surgeon recommended antibiotics for life. I just turned 63, and I am relatively healthy with no metabolic disease. Before my dental exam last week I took 4 amoxicillin prescribed for me by my dentist before the exam, but I was told that surgeons don’t regularly recommend it. I’ll have to ask about this at my next ortho visit in Dec.
I’m in the U.S. and have been going to my dentist for about 27 years. She is deferring to my surgeon.
As an older hip replacement and heart bypass patient, I take the antibiotic before any dental procedure. Actually both my cardiologist and orthropedic surgeon recommend as well. I am comfortable with this.
I had a knee replacement in 2019. My dentist wants the antibiotics. But what they want me to take, 2000mg of amoxicillin, makes me so sick to my stomach. I take half of what they recommend before the appointment then half that night if I had something big done like a root canal.
Yes that’s the dose we use when we do
Since our gut health is so important to our immune system, how does a PPI’s effect on the gut microbiome factor into the possibility of infection since PPIs lower a person’s ability to fight bacteria? Or is this only the case for bacteria that enters the gut orally?
The Medical Profession was already warned way back in the year 2000 that we were becoming antibiotic resistance (I worked in a doctors office and saw the warning from either the CDC or the AMA. And we still make these recommendations to take antibiotics willy nilly. My ortho still recommends it for a lifetime. I grew up in the 50's and 60's and docs put everyone on penicillin for everything. Thank goodness I was allergic to it.
Still have OME (Original Manufacturer Equipment) joints. My dentist normally gave just ONE antibiotic before a dental procedure. I told him "full course or none at all" because of surviving bacteria from the prophylactic antibiotic dose. I've received no antibiotics since. But if I need a joint replacement, thay'll be another story.
I had taken two antibiotics close together for two separate dental issues. Developed c dif and had a fecal transplant which cured the c dif. Then 10 months later had a hip replacement for which I had to take an antibiotic and my c diff came back. Later when I had a dental procedure my orthopedic doctor wanted me to take the recommended antibiotics to protect against a possible infection and I was terrified it would have negative consequences due to my previous history. I took them had no infection and no worsening of my c diff which I still have to this day and am managing it with an every other day antibiotic. Ironic, in that to manage my symptoms, I have to take an antibiotic which is what caused the issue in the first place.
Up to the patient? Maybe after being well counseled by their doctor, as you’ve done here.
Good discussion and reasonable advice for taking antibiotics before a dental appointment if you have had a joint replacement. Do bad you didn't mention what your advice is for patients that have had a heart valve replacement?
After my knee replacement no antibiotic was needed/recommended/required. Then when I had a reverse shoulder replacement I was told I had a prosthesis and would need to take antibiotics for the rest of my life!!! Different practices. Now I’ve had a meniscus clean up with no mention: the same practice as the shoulder. Recently a dentist told me no need because what we weren’t doing anything that should indicated it.
I’m not convinced it’s needed although I did have an abscess before the shoulder replacement that then required an implant be removed as it got loose! That took long enough to replace that I started mentioning the meds and the oral surgeon was good with it. Still no infection in the joint!
Do I like it no! It takes me a longer course of antibiotics to normally clear an infection. This once and dome just seems to be asking for more trouble!
Each surgeon is so different on what they think. I've worked in dental for 35 yrs and have seen so many changes in the thoughts on premeds. We have some they expect pts to do it for life, some say for 2 yrs and any time for between. We still have some that are doing it the old way with several days prior to appt, then so many days after.
Yeah it’s tricky
I had total Mako knee replacement on 10/18/23 and he said yes I need to for 5 years before going for dental procedure. So I will.
Thanks. I really been looking at this issue. I had a knee replacement two years ago. Four years before that my sister was having gum surgery and her dentist insisted on her taking Cipro. (No joints replaced) she got C-diff. Hospitalized four times within a few months and almost died. She is fine now as she had a fecal transplant, But her experience has made me very leery of antibiotics. Both my dentist and surgeon are older and very conservative, but I am really leaning right now towards not taking antibiotics for just cleaning and only for things like root canals.
My husband received the Watchman implant and his doctor told him to take an antibiotic before any dental procedures. He has also had both knees replaced and it getting ready for a hip replacement.
I also forgot to say my husband has RA and takes steroids and methotrexate.
My ortho said only for major dental procedures, extraction, oral surgery, not for cleaning. Thanks
Now that makes sense.
Unfortunately, there are still Dentists who say you need antibodies. I found one that said I needed to turn up an hour before my appointment to take my antibiotics and needed to stay in his office until my appointment. That was September 2023.
Interesting
Thank you for discussing this topic. I had a knee replacement 6 years ago and my surgeon still wants me to take an antibiotic even though my dentist disagrees. But, my dentist won't treat me until my surgeon signs off.
Yeah it’s tricky for sure
I do take antibiotics before dental appointments every three months. I agree it must be decided on an individual basis with consideration taken for other health factors. My dentist and my periodontist practices always check with me to make sure I have taken the Rx for which my dentist practice writes the script.
I presume you have gingivitis (just like my "friend" I wrote about in another comment stream). I would expect the advice to be different for a person who has gingivitis.
@@Joy21090 possibly. Taking antibiotics is based on whether or not you have one of three other conditions. In my case I have autoimmune conditions and therefore take the prescribed antibiotics. Good luck to your friend.
I was required to wait 6 months after total hip replacement to visit the dentist.
I’m assuming the patient history should play a significant part in the decision-making process. As a person with a compromised immune system, the surgeon, the dentist, and the immune specialist all agreed that prophylactic antibiotics was/is appropriate.
I have another perspective. Clindamycin seems to be the antibiotic of choice for dentists. I suffer from Crohn’s disease. I have had multiple bouts of c. Diff. Recently I had some dental work with a Rx for clindamycin. I ended up in hospital for three weeks with a major c.Diff attack and subsequently a flare triggered by the c. Diff. The consensus amongst the GI doctors was that clindamycin is the absolute worst antibiotic for triggering c. Diff complications. When we mentioned this to my dentist he was unaware but will bear in mind for future reference. I will definitely bear it in mind as each time you get it makes a recurrence more likely and each recurrence is likely more serious than the last
Well darn. I had my hip replaced in January of this year and my Ortho doc said take antibiotics for the next two years before going to the dentist. I would prefer not to take them at all as I am healthy. I was pumped with enough antibiotics right after hip replacement. I can see one year maybe. Guess since I'm in charge of my own health, I'll see if I can get away with one year instead of two. Thank you doctors for addressing this issue. I love the humor thrown in also.
I had a hip replacement in February and will be seeing the dentist next week, ortho surgeon said it’s no longer necessary to take antibiotics. I had my other hip done 5 years ago and it was the complete opposite like most are saying take antibiotics before each treatment
I've had total joint replacements in my jaws. These were done by oral surgeons and I was prescribed 1000 mg of antibiotics prior to dental appointments.
The point you made about not getting a full round of antibiotics makes you wonder how it would help at all or even make things worse.
At some point my surgeon said the antibiotics wouldn't be necessary after 10 years.
I had never thought about how disruptive it could be to have only a single dose of antibiotics until you just mentioned it. I don't like to take antibiotics often because they are sometimes over prescribed.
I could see the need for precautions after joint replacements but a different approach might have been better. Especially having just one dose before dental work and possibly disrupting your whole system.
I can also see how it would really be difficult to track thousands of patients for a number of years. Each person's medical history should override the normal standards set by medical groups.
Luckily I never had any problems after my joint replacement surgeries. I just hope the replacements will last and I won't need any more.
Thanks for sharing another great and informative video!
I have to take Clyndimycin before dental appointments. For 2 years.
My PCP left research at a huge school of medicine. He is a board certified infectous disease doc. This exact issue came up and I ask for a dental antibiotic script. He had a very strong opinion that it was not needed. Also, I have a partial replacement knee and that did not make any difference to him. Everything went well. I had a coworker that almost died from a "deep" tooth cleaning, so I am reluctant of dental stuff. Thanks for your advice.
It’s complicated for sure
Some of these comments look like over use of antibiotics.
Two TKRs. Quarterly dental hygienist. Last time the hygienist asked if I took the prescribed antibiotic. My answer: I always lie. She didn’t flinch.