Many individuals with prosthetic joints take antibiotics prior to dental procedures, such as routine cleanings, in order to protect their joints from infections. This is largely due to the belief that any bacteria found on the teeth and gums could migrate into the bloodstream during a dental cleaning and infect prosthetic joints. While it is great to be cautious, a recent panel at the American Dental Association Council on Scientific Affairs developed an evidence-based clinical practice guideline on the use of antibiotics that indicates that antibiotics may not be as necessary as initially thought.
The Skinny on the Study
The panel examined information gathered from a previous panel (back in 2012) as well as information from four separate studies on the subject. The panel decided that patients with prosthetic joints were not at risk of infection from dental procedures for two reasons:
- The first was consistency between results, in that the results of 3 of 4 studies failed to show an association between dental procedures and PJI, and the results of the fourth study showed a protective effect of dental procedures on PJI. The second was that, although the number of studies was limited, it is unlikely that the results of the additional studies would have changed the conclusion.
- With no evidence that there is a risk of infection related to dental procedures, there’s no benefit from taking antibiotics, and, in fact, there are risks.
Inherent Risks of Antibiotics
The panel went further and identified three downsides to the use of antibiotics for those with prosthetic joints during dental procedures. Firstly, there is a risk that the overuse of antibiotics will give way to bacteria that are resistant to them. This can spell trouble, as this will make prosthetic joint infections deadlier and harder to treat with current antibiotics.
Secondly, there is a risk of adverse effects from the overuse of antibiotics. The panel specifically mentioned C. difficile which is a bacterial infection that can cause diarrhea to deadly inflammation of the colon. This infection usually only occurs after extensive use of antibiotics among older patients caused by killing off natural symbiotic bacteria in the digestive tract. This is worrisome given that many dental procedures are completed over a longer period of time.
The last concern is the overall cost of antibiotics. A report from 2013 indicated that the total cost of amoxicillin administered to patients with hip and knee prostheses could exceed $50 million.
How to Protect Yourself
Fortunately, there has been great advances recently in the development of antibacterial implants that destroy bacteria mechanically instead of through the use of antibiotics. With that being said, many are still in development and have not gone beyond human testing. The best course of action is to keep up on the maintenance of your teeth and any dental implants you may have. This includes brushing, flossing, and regularly visiting your dentist. If you live in the Orlando area and are in need of a dentist, please consider visiting Michael L. Weinstock, DDS in Altamonte Springs. If you would like to schedule an appointment, or have any questions for us, please give us a call at (407) 834-6446.