Do people with artificial joints need antibiotics before a dental visit?

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  1. Linda Wilhelm

    I had my first joint replacement in 1998 and now have a total of six , with seven additional fusions that have metal and pins. It was a few years after my first procedure that I was told I should have antibiotics when having dental work done. I have a friend who had a terrible infection in her artificial knee, just the thought of getting one after seeing what she endured terrified me. So even though I had no problems with infections, I began taking the antibiotics, every year my reaction to them worsened. I asked about taking a different one as I couldn’t imagine that everyone, regardless of their weight should take the same dose, mine was 2 huge pills, pre and post dental work. I was told there was nothing else so last year, after being ill for a month from taking the antibiotics, I decided that I would NOT pre and post medicate for dental work. I felt I was fully informed of the risks and the benefits did not outweigh them for me, which considering my friend with the knee infection says a lot about how ill the antibiotics made me. I was comfortable with my decision, but now even more so. Thank you Healthy Debate for publishing this article.

    • Allison

      Your comment gives me heart, after a very discouraging experience of planning for, then having to cancel, hip-replacement surgery due to the antibiotics before dental work issue and a personal history of rather recent c. difficile. I couldn’t envision a postop recovery, which would be challenging under normal circumstances, characterized by arguments with dentists about whether or not they would treat me without premedication, as the outdated premedication guidelines seem to predominate at least among the practitioners I’ve seen (and I’m in a major U.S. city).

      The fact that you were already noticing adverse GI effects from antibiotics speaks volumes. It leaves one to wonder what scenario would unfold if a patient became unable to take antibiotics due to untoward effects, if not frank c. difficile. Would the dentist then inform the patient that all future dental treatment must be foregone, due to remote risk of a hip infection, and that repeated c. difficile relapses or even “just” severe diarrhea were simply the tradeoffs one must accept for hip replacement?

      The “debate” is ridiculous and massively disempowering of patients. Are people told to abstain from driving because they could become maimed in a car crash? Not the greatest analogy, but there are probably a hundred more that are currently eluding me.

      • Deed

        With any antibiotic use, it should be given with Lacto basilius, a probiotic. This helps keep the flora in the bowel a good flora. At the hospital where I work, they have given this combo to hopefully to keep c-dif at bay.

  2. Allison

    Thanks for the excellent article. I wish I were a Canadian rather than a U.S. patient so that I could access the help of the Health Navigator. I just went through the emotionally grueling, anxiety-provoking experience of cancelling a hip-replacement surgery that I’d had planned for many months. The reason was that, only a few weeks from the surgical date, I discovered that both the ortho surgeon and my dentist were going to state that antibiotic premedication would be needed for virtually every dental procedure, including tooth cleanings and novocaine injections, for “lifetime”! Two years post-hip replacement, which has sometimes been the recommendation in the ever-shifting AAOS guidelines, and which is worrisome enough, had gone out the window.

    I had c. dificile colitis a year and a half ago due to clindamycin, a wide-spectrum antibiotic (and one that’s popular among dentists). It was given to me for about ten days following a tear-duct surgery. I am at increased risk for future episodes of c. diff. Making matters worse, my dental visits aren’t limited to routine cleanings once a year. I am strongly recommended for three cleanings, and in a typical year at least one other dental issue, sometimes more, will arise, e.g., a cavity or a deteriorated crown that needs replacement. So I would be told to take antibiotic premedication for up to five times for dental work, in addition to for whatever nondental issues might require it.

    This pattern of repeated antibiotic prophylaxis within a narrow timeframe is dangerous not only to people like myself with a history of c. difficile but to the general population, as antibiotic resistance is a skyrocketing problem. I felt the ortho dr. and the dentist were both trying to scare me into acquiescing with their recommendation. I do not think either knows firsthand of the terror of a dysenteric infection triggered by an antibiotic that so far has no reliable cure. People who contract c. difficile can become housebound due to incontinence, require major colon surgery, and, not uncommonly, succumb to the infection, especially if they are elderly and frail.

    I was dismayed by the reactions I got from doctors each time I raised my fears of a c. difficile recurrence. They ranged from “Your infection was a long time ago” (a year and a half; NOT long, but in any case, duration not relevant) to “What you REALLY have to worry about is … ” [followed by scare story about someone who developed a catastrophic hip infection] to “You may have immunity to c. diff now.” There is no diagnostic test, as of yet, that would predict “immunity,” and even if immunity were present there is no telling for how long it might last. (I got the latter information about immunity directly from CDC.)

    Dr. Morris’s statement that “Prosthetic joint infections are extremely uncommon while side effects and complications from antibiotics are rather common” really says it all.

    • Lin Stigman

      I had a hip replacement Oct 31
      It got infected and infected my heart valve
      I was in the hospital till Jan 13th
      On IV pic line antibiotics
      Infection has caused mt bp to require beta blockers
      I have been denied dental treatment from where I have been going for years
      I have a new patient app for cleaning
      I am not saying anything about my surgery
      I am asking my primary care dr if I need to take antibiotics

  3. barbara young

    I am very grateful for this information. At the moment I am feeling ill because of a dentist-ordered Cipro dose (on account of hip replacement some years ago.) I am very tired of reading the back-and-forth hemming and hawing statements of the medical profession, both pro-antibiotics and anti-antibiotics for dental procedures. More and more I am thinking that hereafter I shall just have to chance it and not take the antibiotics if I can find a dentist who will treat me regardless. At any rate, thanks for this site.

    • Louise Kryger

      I toke the antibiotic for a cleaning clindamycin 300mg 2 of them. 6 months apart then temporary appointment for a bridge. Then the tooth in the temporary bridge bothered me again. Made an appointment toke clindamycin 2, and the dentist could not find out why. So he did nothing. Made another appointment taking 2 clindamycin, 300 mg. and the dentist still could not find out why.
      Then I got thrush on my tongue. Still have thrush the knee Dr. changed to Erythromycin 250mg 4 tablets. Now I am taking Nystatin mouth wash 10-15 units 4 times a day. Second time for this medicine. Hope this works this time.
      Have another appointment for the temporary bridge to find out which tooth is hurting in a few weeks. Don’t know if I should take Erythromycin 250 mgs 4 of them for metal knee again. Or not to take any more antiboitics for metal knee, I am so confused.

  4. H. Roberts

    The above comments are somewhat reassuring as my dentist says “No” to antibiotics and my very well respected surgeon says “take antibiotics prior to dental work”. I feel caught in the middle as both are highly qualified in their field. What to do!

    • Dee T

      I am in the exact confused patient position. My hip replacement surgeon insists I take 2000 mg of Amoxicillin prior to dental work for the rest of my life, since my total hip replacement surgery in 2009. My dentist spent time to inform me about studies and findings from professional organizations that antibiotics are currently NOT indicated (but they will give them to me if I want them.) What to do indeed. I feel fortunate I have not had side effects from meds. I go to the dentist for 2 cleanings per year plus more for any work needed.

    • yvonne hagelstein

      Hi Mr.Roberts,

      I just read your e-mail, 19 months after you wrote it! I was looking for information as my daughter’s father in law has an infection in his knee after a replacement 10 months ago. I’m not sure if he recently had dental treatment. My husband had a hip replacement 6 years ago and we always make sure he has antibiotics before dental treatment as recommended by his surgeon. His dentist says they’re not necessary. We’ll continue with them but I wondered what you decided to do.

  5. CS

    I am very grateful for having read the info in this article but am at the same time very frustrated. I had a total hip replacement end of October, and today (just a little over 5 wks later) a filling broke off. My surgeon’s secretary became hysterical because it was within 3 months – and you’re not supposed to have dental work within that period (as if you have control over these things!). My dentist very carefully polished the sharp area and put a temporary filling in without touching the gums or causing any bleeding. The reason she did treat me was because I am on antibiotics right now due to a tiny infection at the tip of my scar. But she too was very cautious and would require the full two years of pre-dental-work antibiotics. I feel very uncomfortable having to swallow preventative antibiotics because an infection *might* happen. How many cases are even documented where there is a proven causal link between one and the other??? Has more research been done on this possible connection since the 2009 article that is cited? Should I be looking for another dentist who does not require this?

  6. carol tarr

    I had a hip replacement on Dec5 and a week later a crown fell of, luckily at the back and not painful. My dentist is not in favour of prophylactic antibiotics and I’m waiting for my surgeons opinion. I prefer to limit antibiotics to what is necessary. Wish the “experts” could make their minds up

  7. Louise

    ACCIDENTS: I see a lot of information about taking antibiotics before medical/dental procedures… What do we (joint replacement patients) do when we fall and cut ourselves? I recently went down on the ice, bruised my replaced hip AND had a tooth pierce my face from the inside out. I am healing well but there was a lot of blood and I had no antibiotics on hand. I certainly would not be able to take anything in advance of an accident. What is recommended for accidental cuts, abrasions & wounds? Thanks!

  8. m.e waller

    I try to avoid an overusse of antibiotics. However , I have seen two friends with infected knee replacements and beleive me , you dont want that..Horrific……..Take the prophylactic antibiotics.

  9. pat byrnes

    Would the risk of infection from dental procedures be greater for a person who has had an infected artificial knee treated through an operation and extended antibiotic procedure?

  10. Lesley Dunkerley

    Thank you for this helpful article. I have been informed that there are only 3 antibiotics that I can take during dental treatment. i am allergic to two of them and hesitate to continue to take the 3rd one namely Co-Azithromycin as this one has to be taken for 5 days every time.
    I had hip replacement surgery in 2010 and 2011.
    My dentist instructed to me to go back to the surgeon but I know that he has recommended the antibiotics route.
    I don’t wish to follow his advice. Please do publish more of the research as it becomes available.

    • Paul Taylor

      Hello Lesley:

      Just this week, I was talking to Dr. Susan Sutherland, chief of dentistry at Sunnybrook Health Sciences Centre about this issue. She says that Canadian medical and dental groups are working on common recommendation for joint-replacement patients facing dental work. But it will likely take some time before such a recommendation is released.

      • Mike Orlando

        My knee surgeon graduated Princeton University, Harvard Medical School, and did a fellowship at the University of Pennsylvania Hospital. He is relatively young and
        has won TOP DOCTORS in Philadelphia. He firmly believes that you take amoxicillin
        before any dental procedures, especially cleanings.

  11. Michael Orlando

    With all due respect, I am certain that you are incorrect and I also believe that when these studies are made, that they are done using people with healthy gums. Most people do not have healthy gums. Maybe this study should say “If you have extremely healthy gums, you do not have to take amoxicillin” That being said – I know at least six people that have had a major problem with MVP. One was scratched by a stray cat and had an infection settle in the valve…required a heart transplant…she died five years later. One involved getting a catheter for dialysis placed in his arm that caused an infection to settle in his mitral valve and ended up with a pig valve replacement.
    One 38 yr old in top physical condition involved with continuous dental work and an undiagnosed MPV. According to the Boston MEDICAL EXAMINER. This produced a myxoid degeneration THAT COULD HAVE BEEN CAUSED BY EXTENSIVE DENTAL WORK to settle in the valve and he died. Another was my sons girlfriends uncle…40 yrs old…again extreme dental work and an undiagnosed
    MPV. And more recently, my neighbor dropped over at a concert…again…MPV resulted in an infection in the mitral valve.

    What are the chances of one person knowing that many people with undiagnosed MVP and
    either dying or getting the mitral valve replaced?? I also know a gentleman that again had extreme
    dental work done and ended up with an infection in his replaced knee. Now he has to do it all over

    What is the big deal about taking amoxicillin? It’s not that you sit there and OD on it.
    You take it once or twice a year when getting a cleaning!!!!
    If you want to stop people from taking useless drugs or harmful drugs then write an article on
    the misuse of and the extreme side effects of statins!!!!!!!!

  12. Dianna

    Well that was about clear as mud. I have Rheumatoid Arthritis and the medication I take comprises my immune system so this needs to be considered by both my dentist and my Rheumtologist. My surgeon recommended to tell my dentist about both of my total knee replacements. I wish everyone could get on the same page. I see as I said a Rheumatologist but I also see a sleep apnea doctor and my GP who treats my high blood pressure and my diabetes. So basically I’m up a creek without a paddle.

  13. Julie

    I have been taking amoxicillin before dental appointments for four years with no problems. The last time I took the antibiotics, ended up with a c diff infection, became dehydrated and spent four days in the hospital.

    I am trying to find out the right protocol for this and so far find many contradictions. I don’t want to go a c diff infection ever again.

    • Debbie

      I feel for you, Julie. I had a TKR 6 mos. ago, and now need some dental work done. My dentist says it’s not necessary to do the antibiotics. My OS says for sure for the first 6 mos. so, I’m holding off the dental work as long as I can. What a pain in the neck, and very hard to deal with, I hope the Drs. Get together and get on board with their recommendations….soon!!!,

  14. dana davis

    Well i had a total hip replacement in August at the VA Hospital and my dentist will not do any work at all if i haven’t taken my antibiotics. So i guess its up to the dentist

  15. joyce throm

    I had my hip replacement in March and had a very difficult recovery due to my surgeon dragging his feet getting me into physical therapy. I would never want to go through that again.My surgeon and dentist are both on board with antibiotics, as are other dentists I consulted with.But,either way,I would have insisted on taking them.This isn’t my first rodeo with high doses of antibiotics and I walked away just fine.However,I will not risk infection,another surgery,or even death when all I have to due is take a few pills.

  16. Dennis Ruffo

    Still confusing, however, I will continue taking antibiotics until the research and advice is conclusive. I did forget to take it once and nothing remarkable happened.

  17. Claudia Parfitt

    I had a hip replacement 2 years ago. My surgeon says yes an antibiotic everytime I have my teeth cleaned (which is every 6 months). I am a very healthy person, never get the flu and rarely get colds although sometimes I am aware that my body is fighting something off. Gone in a day!
    In Feb. 2015 I took an antibiotic for a tooth cleaning. In March I got a cough that went on for at least 6 weeks. I ignored it because I did not want a Doctor to give me another antibiotic. One day it magically went away only to come back in August. Again I did not want to take an antibiotic but I was starting to feel week and tired and it would not go away. I do take probiotics as well. By the time I went to the Doctor, she said that I had pneumonia from listening to my chest. But when the x-rays came back no pneumonia was seen. This is the first time in many years that I have needed an antibiotic and I feel that taking one on a regular basis has comprimised my immune system.
    As a matter of fact a research scientist that I know and attended his lecture. He said that everytime you take an antibiotic you weaken your immune system and the next time something comes along you will get sick easier. I believe him and feel that I have just experienced this. My dentist says no antibiotics after 2 years. I think that I will forego it next time. I am scared …..but I am used to good health. I would rather have false teeth than all kinds of health complications. So now I am going to be scared to have my teeth cleaned.

  18. Barbara Willis

    I was to have a hip replacement in a couple of days after waiting some months for it. I was not informed about not having dental work. I had an extraction 3 – 4 weeks ago and am having a filling tomorrow. I rang the Dentist to see if this would mean that I wouldn’t be able to have the operation. Was told to go ahead with the dental work. I decided to ring the hospital and was informed that because I had had a tooth removed a few weeks earlier and was going to have a filling that the surgeon wouldn’t go ahead with the op and am now having to wait until late November, early December. I had not been informed by my hospital in Australia, that I shouldn’t get dental work done prior to the op. I am very disappointed as I cannot walk without my wheelie walker and in pain. I am 83 years old, quite fit and healthy. There is nothing I can do but accept the decision of the Hospital. I just wonder how many people have this op not knowing that they probably shouldn’t. Thank you for your article and will be interested to hear what my Dentist says tomorrow when I attend for the filling.

    • Libby

      Hi Barbara. In Canada it is normal practice that the surgery will not be performed unless the teeth have been cleaned and all dental work done. The hospital have to have the written documents to support this. Of course, if you have to have an extraction, they will need to wait until there is no possibility of infection.

  19. Sharon jones

    Knee replacement and dentist checkup before op. two weeks before and pain in my top right molar.. Should I see my dentist

    • Paul Taylor

      If you are having pain in a molar then it makes sense to see your dentist and possibly your doctor, too – depending on what the dentist says.

  20. Bert E. Tagert, M.D.

    I wonder how many prosthetic joint infections Dr. Morris has seen or treated? As an orthopaedic surgeon, they are not pleasant for anyone. Every ounce of prevention is worth pounds of treatment. Are we exchanging one form of treatment with little evidence for another more potentially dangerous form, also with little evidence?

    • Libby

      What is your medical opinion on getting a tattoo after an hip replacement?

  21. Patrick Loughran

    I had a partial knee replacement nine months ago. I was told by my dentist that I needed to take an antibiotic before every dental visit . When I got my prescription from the pharmacy I was told I would have to take this the rest of my life. I am confused as to the need to take it or not take it. What would you recommend I do??Thanks

    • Libby

      Hi Patrick. Yes you need to take them about one hour before your appointment. The last thing you want is to get an infection in the joint which would cause much more pain that you had before, and it would take a long time to get better. Better to take the antibiotics than get an infection.

  22. Libby

    I had both hips replaced and always take antibiotics before any dental work. But now I want a tattoo on my wrist. Would I need to take antibiotics, and what are the risks? Any thoughts on this.

  23. Paul Harris

    I am in Australia and have just been in hospital for 2 weeks due to my right knee becoming infected after receiving an annual dental checkup without antibiotics. The knee is 3 years old. I am 56 years old.
    As a victim (for want of a better word) of a non antibiotic dentist I can certainly tell you that any discomfort or inconvenience of taking antibiotics before dental work is nothing compared to what I have and continue to endure right now. I have a pic line going to my heart feeding penicillin from infuser bottles every 24 hours for the next 6 weeks.
    As said elsewhere, eat Lacto basilius yogurt while taking antibiotics. I am certainly doing this right now to help offset my 10,000mg per day (yes much larger dose than 2 huge tablets before and after dental work!) of penicillin.
    I am an actual case, not a hypothetical “could happen may happen” as mostly discussed here.
    Signs of an infection such as shivering, weakness in the legs as well as strange pains and a high temperature will occur 3 days after the cause. My dental work was on a Saturday lunch time. I was taken to hospital with the above symptoms on the following Tuesday afternoon. I did not put 2 and 2 together, but my specialist (once I did see him a day later) knew what has happened.
    Please take my warning. I can tell you, you do not want the 8 weeks I am now experiencing.

  24. Denny

    This requirement is very confusing. I am 65 years old. I am very active. Most activities I participate in are “safe”, meaning that I would not encounter skin-breaking injuries. However, I kayak, hunt and do yard work. I have scraped, scratched, cut and punctured myself doing these. I had a TKA 4years ago and a THA 2-1/2 years ago. I continue doing all these activities without using antibiotics. Why for routine dental cleaning? I floss every day, sometimes it bleeds. Similar to Libby’s question, what effect can these skin-breaking episodes produce and, other than avoidance, what to do?

    • Denny

      Neglected to include that my next THA is less than a week away.

  25. Brenda Vilandre

    hi my name is Brenda. I recently had a totalknee replacement. I am coming along fine. My surgeon recommended that I take an antibiotic (Azithromycin) before any dental work. I am allegice to penicillin. the recommeded dosage is to take 4 pills (250 mg.) 1 hr before having this done. I am concerned that this is too much. Please advise. thank you

    • Paul Taylor

      It is alway important to let your doctor know if you have any known drug allergies. And it sounds like that’s what you have done.
      Azithromycin is an antibiotic that is sometimes prescribed to patients who have an allergy to penicillin.
      In terms of the dose, you really have to discuss that matter with the doctor. If you are uncomfortable raising the issue, then talk to a pharmacist.

      By the way, many people think they have an allergy to a particular drug – but don’t really.

      You may find the following web-link helpful ….

  26. Jupiter

    Just found out I need to have 2 teeth extracted, as they are near the front of my mouth, a flipper needs to be made so this has been scheduled for Tues. Jan. 19 which is just 6 days before my total hip replacement!!! I hope this doesn’t compromise the surgery…I tried to phone my surgeon as soon as I found out but his office was closed on Friday afternoon. According to my dentist, this time-frame is OK. Anyone know for sure whether the Canadian hospital will be fine to go ahead with my surgery? I have been on antibiotics for a week and they’ve extended them for another few days.

    • Janet

      Dear Jupiter,
      I hope you are well since this reply is late. But I just wanted to share my story with you. I had a RTH done 4 years ago. I was in so much pain and just wanted it over with. I told my surgeon that my mouth was ok, thank God he made me get a check up prior to surgery I was not ok needed several teeth extracted, should of had root canals, and capped to save them which I regret now. But his words to me were if you have surgery with any type of dental infection it would be Catistrophic!! Dental work is so very expensive even with insurance. I hope you had the surgery and are now recovering. And I think that we are all different and some may need antibiotics post op and others not. Listen to your body ask your doctor questions. They work for you, I interviewed doctors before my surgery. Didn’t like the first one but loved the second. Good Luck!

  27. Heather

    thank you folks! I am a new member of the THR crowd, having undergone the procedure in October, my surgeon, a fantastic fellow, says take antibiotics prior to dentistry procedure, however since my procedure, I have have UTI and pneumonia; took antibiotics bit my GO was not concerned about possible infection attaching to my new hip; if no concern with pneumonia, why with a tooth repair; I will go with the flow and deny antibiotics for my up coming dental procedure. Thank you for sharing this important information;

  28. K Leary

    If the Cleveland Clinic, where I had my hip resurfacing done, says I should use antibiotics when having dental work done, I will.

  29. Barbara K Koppenhaver

    This article is very enlightening, but I am still confused. The orthopaedic surgeons, dentists and pharmascists are all giving different advice on this matter. The first I heard about it was in my knee class after surgery. It was not noted in my discharge procedures, my dental hygienist was alarmed that I hadn’t mentioned it and stopped the cleaning and consuilted the doctor in charge who said it was up to me if I wanted to proceed. I was alarmed and asked her to FAX my pharmacy. When I went to pick up my antibiotics he told me it was the law that we had to have them an hour before each cleaning, so I took the medication and went back an hour later. Ithink it is important that all 3 of these individuals get together and issue some kind of statement to their patients. I thought the whole thing was overkill, but my pharacist was adament. Most people don’t question theier health care providers about these things and the public needs to know the truth. Are their any statistics available on how many people have actually been infected?

    • Ezilu

      I got infected!!! 4 mos in the hospital with septic arthritis!!! 1 hip replacement, broke my acetabulum during recovery, now have full hip replacement. Just take the pills, not worth the hell.

  30. Lynda Simpson

    Thank you for this site. Even though a decision is still in the works. The information helped me decide on my dental work. Which was not to worry after two years of hip replacement. But be diligent not to get an infection in the blood of any kind. Also good to see Canada and USA together on this issue as I needed dental treatment while vacationing.

  31. Deb

    After reading everyone’s comments, I debated whether I should post a reply or just remain quiet. I decided the other side of this discussion should be heard and read. I acquired an infection after my hip operation a few years ago. I am currently going through treatment which will involve four operations on my right hip in total. The pain, isolation, lack of dignity, loss of mobility not to mention six months out of my life and the cost factor that one goes through is something I wouldn’t wish on my worst enemy. I understand that the chances of this happening to the majority of the population is incredibly small. I felt the same way. This was the last thing I thought of when I started having problems soon after my operation. My Drs. never considered that option either – I was the first to acquire an infection on his watch. Very upsetting for all. No one really knows where infections come from and how they happen and why. If there is still a question about a relationship between dental work and prosthesis infection, I would gladly take the antibiotics that might prevent this. As it stands with me now, that’s exactly what I have been and will be doing for the rest of my life. Truth is, once we have foreign objects placed in our bodies we cross to the other side which is the unknown. The medical community doesn’t have the answer to all the questions that arise with these devices and the reaction to bacteria in the body. But, until the answers are clear and concrete, perhaps the occasional use of prophylaxis before dental procedures is a harmless step for peace of mind.

  32. Beth Nimmo

    Thank you for this thoughtful and clearly laid out article on the use of antibiotics before Dental procedures. I have been investigating this question since 2011 when I had a TKR. Great to find Sunnybrook Hospital offers this Health information forum.

  33. John Canzano

    It seems to me to be common sense that preventive medication for a non-existent condition is an overreaction. I have just finished a second total hip replacement and have had a number of dental procedures without the support of any antibiotics. I did not experience any adverse reactions in connection with the hip surgeries and the dental work. The bacteria in my mouth is still there when I floss ( and possible bleed ) or when I have dental work done. I think that when proper personal dental hygiene is employed normal dental work dose not pose a risk. In conversation with my doctor he stated that the process should be rethought though, when oral surgery is being employed.

  34. Livonia Tippett

    Yes, but what if after joint replacement you need a flat polyp removed from your colon, could there be a risk of sepsis?

  35. Scott Wooder

    Once again I’m in my office, being asked by a dentist to prescribe antibiotics for a patient with a previous total knee replacement. It’s clearly contrary to CDA guidelines and if the dentist has strong feelings she can prescribe anyway.
    It feels like a transfer of medical legal risk onto me. The dentist and the orthopod are the ‘experts’, why am I involved at all?
    Can’t we settle this once? Every time it costs me 20-30 minutes and the dentist will not proceed without the antibiotic in any case.

  36. ELizabeth

    Now I’m so confused, I had THR last year. I can’t get any app to my surgeon before my dental app. SHould I take the antibiotic 1 hour before or not?

  37. Dave Hodgson

    I had a TKR 5 weeks ago at Sunnybrook ( Holland) and have a dental cleaning apt in a week. I have the antibiotics but do I need them? What is Sunnybrook’s response?

  38. Rudra Hellerio

    Thank you for a very helpful explanation of the still ongoing debate. My dentist insists on using antibiotic prophylaxis. I will find a new more sensible dentist.

  39. Becky Windhager

    I had hip replacement the end of January, and need to have my teeth cleaned. my surgeon and dentist are both telling me to take antibiotics before i go. My family doctor says the opposite, because she is more up to date on the latest reports .I trust her judgement more. I really don’t want to take the antibiotics..not sure what I should do?

  40. Marion Thomas

    Thank-you for this informative article. I have been told my surgeon’s receptionist that I should take antibiotics forever before a dental visit, my dentist, the dental school where I go for dental cleaning all echo the same thing.
    I’m truly not happy about this. This year, I have been to the dental school 6 times, the dentist once, and the periodontist once and all required doses of antibiotics, particularly the latter prescribed them for 10 days.
    I am a healthy 72 year old and have rarely taken antibiotics throughout my life. Now, 2 years after a hip replacement, it seems that my system is flooded with them.
    I have recently had a sty in my eye and it seemed a though it wouldn’t heal. My feeling is, that my normal high resistance to such things has been diminished. Even the polysporin eye drops from the drug store had no effect. Garlic juice has been my last resort and seems to have killed the infection.
    If the medical profession insists on antibiotics for dental work, I for one will make sure I have the vertical minimum of appointments.

  41. Joan Baker

    Informative answered any question I had thanks. my biggest concern was drug resistance and was there a real need to comply with doing this? Now I can make a conscious choice based on good presentation

  42. DIANE greenman

    My dentist and my orthopedic doctor insist I take antibiotics pre dental cleaninig. It’s already compromised me. I am limited to a few medications. This is dangerous for me if I truly get an infection of any kind

  43. L haller

    Because a find some blood at the gum line during a routine brushing, I am assuming that such an opportunity for infection would be equivalent to some bleeding during a cleaning. I have a cleaning appt. one week, a followup uncovering implant appt. the following week and a dental appt. for the cap impression the following week. I am not comfortable taking the prescribed 2000 m. each separate visit. I would take the drug for the most necessary procedure.
    Any suggestion?

  44. Mike

    Can mouthwash be a good precaution rather than antibiotics before dental work?

  45. Adela Matarrese

    I am having teeth cleaning and had surgery on knee in Sept 2015 and had epidural in lower back I also will be getting surgery on right knee. So I am very much concern.

  46. Doug Moffatt

    After 6 years of artificial knees my dentist stopped insisting that I take antibiotics before dental work, In August of 2015, I had my regular cleaning. Dentist noted a small bone fragment had worked its way to gum surface. Told me to come back tomorrow and he would “snip” it off. I did. He snipped. 2 weeks later I awoke with a series of aches, pains and swelling in my left knee. I went to local emerge and after wasting most of my day with all the usual tests (blood, urine, heart rate, etc.)
    I was given percoset for the pain and told to go home and manage the pain. Next a.m. I could not get up and my left knee looked like a basketball. We called 911 and asked for ambulance. The medics got me downstairs and into the vehicle. A doctor at Uxbridge Cottage hospital took a fluid sample from the knee and very soon said I had a severe infection of a type of material normally found in the mouth. The ambulance took me to Markham Stouffville hospital where I was immediately rolled into an operating theatre where the doctor removed the implant and put in some kind of spacer. I was placed on an insulin pump which I wore for 4 months. In December I received a new replacement knee and went on therapy & physio for several weeks.
    I was told after all this that if I had not gone to emerge when I did. I would not have lived.

    I now receive antibiotics 1 hour before any dental work as do all of my dentist’s patients who have some artificial feature.

  47. Joyce Andrews

    Well I have dental appointment for cleaning tomorrow. Had knee replacement 3months ago, have 4 amoxicillin
    capsules 500 mg each to take one hour before appointment, That’s a lot to take at one time, what’s your thought.

  48. June delmont

    I am due to have aTHR in January and have got a small pocket come up on my gum a the side of a new crown i recently had placed. I feel terrified over having this so close to having my op. As my Orthopedic surgeon insists upon have antibiotics before dental work and has even given me a letter to take to my dentist who does not agree. When i see my dentist about this lump or pocket that has not gone down he may now suggest deep cleaning around this new crown and with so little time before my surgery i feel afraid in case if i am still caring bacteria at the time of the op. The terrible thing is i have actually met another one of my surgeons patients who
    Lost her leg due to germs traverling from her teeth to her mental knee following having her teeth cleaned. I feel very unhappy because although my surgeon is one of the top in the country no one is listening and i have met someone who has lost her leg from mouth bacteria after cleaning. Please help me know what to do i am so confused. Thank you

    • wuss

      I think I would be looking for a new dentist. At the very least, get another opinion.

    • Maggy

      I had a TKR in July and another one 5 weeks ago…have an apt tomorrow for tooth extraction and an implant….have 2000mg of amoxicillin to take…am worried that it is too soon after my last surgery…am very healthy and very chemical free…do not take any meds..have never taken so much med…took some amox last week and left me restless, unable to sleep all. Isn’t and very tired…

    • Patricia Pearson

      I’m very afraid myself. I have apt on 21st this month. Just don’t know who to believe.

  49. irene sanchez

    this article has been a big help, I had both knees replaced 8 years ago, fixing to have dental work done. am not so worried now about anti-biotics. thank you

  50. judith battle

    Thanks. I a registered nurse , my grand son who is 17yrs has Down Syndrome had heat surgery at age 1year. Five months ago he had a hip replacement. His parents said his cardiologist said he did not need antibiotics. However with some nudging from the dentist started giving it to hi as he had many invasive procedures. I a now leaning toward stopping it after reading this and many other article, including one from American Heart Association? I use and support conventional but lean toward using it wisely. For me holistic and homeopathic is the way to go.

  51. Jim Richardson

    I am in the same boat !! 12 yr old hip replacement and surgeon recommends anti bio the rest of my life, dentist follows surgeon recommendation. Cant blame the medical prof. Medical Malpractice issues make it easier to say “take it forever” My problem is intestinal and no doubt the meds kill “good bacteria” Its up to the patient I guess to roll the dice although it does not appear to be much of a gamble. I am definitely going off for simple dental cleaning. Thanks — JR

  52. Barbara Crecelius

    I am required to take four amoxicillin before any procedure by my dentist. My gastro doctor says it would cause me to get C-diff again. What am I supposed to do??

    • Patricia Pearson

      I’m very sorry this is happening to you. I thank you for sharing this cause I’ve been told i don’t need the antibiotics but i will insist on them. I pray for your health to improve.

    • Jim Houck

      I am very interested in your situation because mine is very similar. Please let me know what you decide and what happened.

  53. Sylvia

    I had TKA that failed and a TKA revision. About 1 year after, I had a simple dental procedure and was told it wouldn’t require pre-antibiotics. It was the one and only time I didn’t take the antibiotics. Within a couple of months I had a really bad infection in the joint. Couldn’t walk, the pain was unbelievable. Orthopedic specialist put me on 3 antibiotics for about 3 + months to reduce it to a point that he thought I would be okay with. I understand the infection is never fully removed. He basically told me i was lucky to have my leg and be alive. In the pathologist’s report 1 of the bacterias found was also one found in the mouth. If it was not related to that dental appointment, it is an awful big coincidence. It occurred about a year after the revision surgery and the 1 and only time with no pre-antibiotics. I now have little quality of life, as i am left with a leg that is next to useless and chronically painful. It has caused many bad falls. Something as simple as getting off the toilet can be a big deal. Sad that since I was 52 I have lost what life i once knew. Who wants to take that chance? Not me……

  54. Hilary western

    Can gastroenteritis bacteria get into replacement hips where blood doesn’t flow freely?My husband has had three artificial hips caused by one getting infected.

  55. Eileen broderick

    This has been helpful but my dentist still insists that due to a hip replacement I must take prophylactic amoxicillin before dental procedures .
    Antibiotics set off bouts of diarrhea that make me very reluctant to use a medicine that has no proven link to infection in joint replacement.

  56. LenirD

    If the culprit is gum bleeding during a dental procedure, what do people who suffer from gingivitis and therefore bleeding gums do? How should this be addressed as far as the use of antibiotics and prosthetic implants go? Just curious…

  57. Patricia Pearson

    Well this was not clear enough for me and im not really health, but one doctor office say its ok but still not sure so i just trust God he’s the only sure one to listen believe. Patricia

  58. Peg Paulson

    After having the dental work done now my husband has extreme pain in the surgery area. Could he have gotten infection even though he took the antibiotics?

  59. Jim Houck

    I recently (last September) had my hip replaced after a fall. I now need to go to the dentist but I’m apprehensive as I caught C-diff when I was in the hospital. Or maybe I should say that I think I might of had a form of C-diff for a few years. You see I have U.C. and my condition had gotten very bad with what I thought was just my Colitis getting really bad. So now I am very wary of over doing it with antibiotics. I hope you would understand that your opinion would be one of many including my own doctors, thus I hope that you would indeed give your opinion.

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