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Concerns

Which joint(s) have been replaced?

When was the last joint replaced?

Have you had any complications associated with the joint replacement?

Do you have any conditions ("special circumstances") that would put you at a higher risk for hematogenous infections?

Do you have any drug allergies?

Antibiotic prophylaxis for dental patients with joint replacement, according to the American Dental Association:

Prescription for antibiotic prophylaxis for a patient at risk for infection due to a total joint replacement. 4 visits.

Which joint(s) have been replaced?

Total joint replacements of concern to dentistry are the major joints, such as the shoulder, elbow, hip, and knee.

According to the 2013 American Academy of Orthopaetic Surgeons (AAOS)/American Dental Association (ADA) guidelines no antibiotic prophylaxis is indicated for pins, plates, screws, or total joint replacements. The AAOS/ADA 2003 guidelines suggested antibiotic coverage prior to dental procedures for patients with total joint replacement.

When was the last joint replaced?

According to the AAOS/ADA 2003 guidelines, antibiotic prophylaxis should be considered within the first 2 years after a total joint replacement.

According to the same guidelines, beyond 2 years, antibiotic prophylaxis is considered only under special circumstances (see below).

Have you had any complications associated with the joint replacement?

According to the AAOS/ADA 2003 guidelines, a history of prosthetic joint infections is a consideration for antibiotic prophylaxis before dental procedures, even beyond 2 years after the joint replacement.

Do you have any conditions (“special circumstances”) that would put you at a higher risk for hematogenous infections?

According to the AAOS/ADA 2003 guidelines, several comorbid diseases and conditions and special circumstances may increase the risk for experiencing a hematogenous total joint infection. When these conditions are present, antibiotics should be considered.

Patients at increased risk of developing hematogenous joint infection (according to the AAOS/ADA 2003 guidelines) :
  • All patients during the first two years after joint replacement.
  • Immunocompromised/Immunosuppressed Patients: Inflammatory arthropathies, such as rheumatoid arthritis and systemic lupus erythematosus.
  • Patients with Comorbidities: Previous prosthetic joint infections, malnourishment, hemophilia, HIV infection, insulin dependent (type 1) diabetes, malignancy.

Do you have any drug allergies?

Drug allergies may affect the choice of antibiotic used for prophylaxis.

Antibiotic prophylaxis for dental patients with joint replacement, according to the AAOS/ADA 2003 guidleines:

Situation Agent Adult Regimen
Standard general prophylaxis Cephalexin, cephadrine, or amoxicillin 2 g orally
1 h before procedure
Unable to take oral medication Cephazolin or ampicillin Cephazollin 1 g or ampicillin 2g IM or IV
1 h before procedure
Allergic to penicillin Clindamycin 600 mg orally
1 h before procedure
Allergic to penicillin and unable to take oral medication Clindamycin 600 mg IV
within 30 min of procedure

Prescription for antibiotic prophylaxis for a patient at risk for infection due to a total joint replacement. 4 visits.

Patients with no penicillin or amoxicillin allergies

Name: John Doe    DOB: 1/1/50
Address:123 Main Street, Pleasantville, PA
Amoxicillin 500 mg tab.
Disp. 16 tabs.
Sig. 4 tabs. po, 1 hr. prior to dental appointment

Patients with cephalosporin or amoxicillin allergies

Name: John Doe    DOB: 1/1/50
Address:123 Main Street, Pleasantville, PA
Clindamycin 300 mg tab.
Disp. 8 tabs.
Sig. 2 tabs. po, 30-60 min. prior to dental appointment

OK