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Artificial Joint Replacement and Dentistry


There's more to artificial joint replacement than most of us know, but did you know about the connection to dentistry? You might wonder what one has to do with the other. The connection stems from the use of antibiotics, the risk of infection and the collaboration between orthopedic surgeons and dentists.

The traditional recommendation for patients with artificial joints has been to prescribe antibiotics prior to any high-risk dental procedures. These high-risk dental procedures aren't as invasive or complex as you might think; pretty much any dental procedure that may result in bleeding is termed high-risk. These include extractions and root canals, but can be as common as a dental examination or cleaning. When a patient begins to bleed, the patient is at risk for bacteria in the mouth entering the bloodstream, which can infect other places in the body, like artificial joints.

If infected, artificial joints (think hips and knees) can be expensive to heal - like $50,000 worth of procedures to heal. That's why the recommendation has been to prescribe antibiotics prior to high-risk dental procedures. For just a few dollars, a patient can be protected against possible infection from a dental procedure and potentially save tens of thousands of dollars of care down the road, right?

It's not that simple, says Lea Erickson, DDS, MSPH. Erickson is the senior associate dean of student life at the School of Dentistry and a specialist in geriatric dental care. "Rather than a heavy dose of antibiotics, the best way to prevent bacteria from the mouth entering the bloodstream is to maintain good oral health all the time," she says. Erickson says a lot of health care providers use antibiotics as a first line of defense all the time, contributing to a rise in antibiotic resistance in certain populations.

"The current recommendation released by a joint panel of experts from the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) is that dentists do not need to prescribe antibiotics to every patient just because of an artificial joint," says David Okano, DDS, MS. Okano is an assistant professor of periodontics at the School of Dentistry. "Certain patients, especially those with immune system deficiencies, should continue to be prescribed antibiotics. The University of Utah follows the recommendation of the University Orthopaedic Center, which is to give antibiotics to all patients with artificial joints. We teach our students the university's policy, but we also train our students to use their best clinical judgment so they can provide the best care in private practice," he says.

Okano notes, however, that the ADA and the AAOS will likely meet again in the future to review the scientific literature on the issue. For now, patients with artificial joints can expect to be prescribed antibiotics before dental treatment at the University of Utah School of Dentistry.

Originally published April 4, 2016