Apr

10

There is a very low but non-zero incidence of prosthetic joint infection with oral organisms. The vast majority are skin bugs (staph aureus, etc), but also colon, respiratory, and genital cooties on rare occasion travel the blood and land on a metal joint. Such transfers can also occur brushing and flossing, eating, defecating, or with sex. So for most people that’s a lot of antibiotics.

Mostly because of CYA, years ago the recommendation was prophylactic antibiotics prior to any dental procedure that could result in bleeding, such as oral surgery, tooth cleaning, etc. Then the dental and orthopedic organizations got together and said for the vast majority this was not necessary, in fact not advised - due to risk of allergic reaction and increasing bacterial resistance. The position paper said it should be reserved for high risk joint replacement patients, without exactly defining that risk. IMO patients with prior prosthetic joint replacements are high risk, as are others including poorly controlled diabetes.

That said most orthos want pts to keep doing this for ever, which reverts again to CYA.

There is a much stronger case for patients with prosthetic heart valves, though mainly the mechanical type.


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