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To Prevent Joint
Infections
The oral cavity is
a portal of entry as well as the site of disease for microbial infections that
affect general health.
Streptococcus
viridian is
the main infective agent that can enter the bloodstream from areas with
considerable bleeding such as the oral cavity, urinary tract and
gastrointestinal tract. This bacteria may lodge on the heart valves,
inflame the myocardium and cause ulcerations on the inner walls of the an
artery. Patients with artificial joints, prosthesis or
pervious severe infections are at a higher risk. These risks are from an
implied association between dental treatments and joint infections.
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For the
first two years following a total joint placement, antibiotic
prophylaxis is recommended for everyone. After two years, only
high-risk patients may need to receive antibiotics for high-risk
procedures.
Do any of these high-risk situations apply to you?
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Rheumatoid arthritis |
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Systemic
lupus |
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Other
medical conditions that cause you to be
Immunocompromised or immunosupressed |
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Immunosupression caused by drug or radiation treatment
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Malnourishment
|
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Hemophilia |
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HIV
infections |
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Insulin
dependent (Type 1) diabetes
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Cancer
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Some Elderly patients
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All patients in these high-risk categories may
need antibiotics for all high-risk dental procedures.
Premedication is recommended for antibiotic prophylaxis for any dental procedure likely to
cause bleeding.
The American Dental
Association recommends antibacterial prophylaxis for at-risk individuals with
any dental procedure that may cause bleeding such as the following procedures:
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The current regimen:
| Patient type |
Suggested Drug |
Regimen |
| Not allergic to penicillin |
Cephalexin, cephradine, amoxicillin |
2 grams orally 1 hour prior to dental procedure |
| Patients not allergic to penicillin and
unable to take oral mediations |
Cefazolin or ampicillin |
Cefazolin 1 g or ampicillin 2g intramuscularly or
intravenously 1 hours prior to the dental procedure |
| Patients allergic to penicillin |
Clindamycin |
600 mg orally 1 hours prior to dental procedure |
| Patients allergic to penicillin and
unable t take oral medications |
Clindamycin |
600mg intravenously 1 hr prior to dental procedure
*Source JADA Vol 134, 7/03 pgs 895-899 |
is two
grams of amoxicillin, one hour prior to treatment with no follow-up dosage
required. Clindamycin, cephalexin, cefadroxil, azithronycin or
clarithromycin as also suggested alternatives.
At our office we also reduce bacteremias by using an antiseptic
mouthrinse for 30 seconds before any procedures are done.
The most effective reduction in bacteria in your mouth is accomplished by
you. It is urgent that you improve your oral
hygiene care in order to improve you oral health by:
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Rinsing your mouth with an antiseptic
mouthrinse like BreathRx or Perioguard
to reduce the bacteria count in your mouth BEFORE you do the
following:
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Use a Waterpik irriagator on a daily basis.
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Brushing
at least twice a day for 2 minutes or more using a Sonicare
toothbrush.
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Flossing daily or
using an automatic flosser.
All these will
"stir up" the bacteria in your mouth, yet by using a consistent and
regular self care maintenance routine along with frequent check-ups and
professional cleanings will result in an overall reduction of oral bacteria to
improve not only your oral health but your total well-being.
Poor oral hygiene and periodontal
(gum disease) or periapical infections increase your risk for joint
infections.
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AAOS
Guidelines for Joint Replacement
AHA
guidelines.
Guidelines with joint replacement
ADA
guideline and
updates
ADA
PREMEDICATION forms, recommendation and medication table.
Premedication Index
Patient Education
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