Antibiotic Dental Prophylaxis After Total Joint Replacement



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Antibiotic Dental Prophylaxis After Total Joint Replacement

Brent P. Hansen, DO (602-588-4040)

Advanced Joint Care & Orthopedic Sports Medicine

1. Patients who require antibiotic prophylaxis



  • Any patient within 2 years of joint replacement surgery

  • Any patient after 2 years with:

    • Insulin-dependent diabetes

    • Previous total joint infection

    • Malnourishment

    • Hemophilia

    • Immunocompromized patient

      • Inflammatory arthritis (Rheumatoid Arthritis, Lupus)

      • Disease, drug or radiation-induced immunosuppression

2. Dental procedures which require antibiotic prophylaxis



  • Dental extractions

  • Periodontal procedures including surgery, sub gingival placement of antibiotic fibers/strips, scaling and root planning, probing, recall maintenance.

  • Dental implant placement and reimplantation of avulsed teeth.

  • Endodontic (root canal) instrumentation or surgery only beyond the apex.

  • Initial placement of orthodontic bands but not brackets.

  • Intraligamentary local anesthetic injections.

  • Prophylactic cleaning of teeth or implants where bleeding is anticipated.

3. Dental procedures which do NOT require antibiotic prophylaxis.



  • Restorative dentistry (operative & prosthodontic) with/without retraction cord (unless excessive bleeding expected).

  • Local anesthetic injections (non-intraligamentary)

  • Intracanal endodontic treatment; post-placement and buildup

  • Placement of rubber dam.

  • Postoperative suture removal.

  • Placement of removable prosthodontic/orthodontic appliances.

  • Taking of oral impressions

  • Fluoride treatments.

  • Taking of oral radiographs.

  • Orthodontic appliance adjustment.

4. Recommended antibiotic prophylaxis (no second doses needed)



  • First choice: Cephalexin, Cephradine or amoxicillin; 2g orally 1 hour prior to dental procedure.

  • If penicillin allergic: Clindamycin, 600mg orally 1 hour prior to dental procedure.

  • If unable to take oral medications:

    • Cefazolin, 1g IM or IV 1 hour prior to dental procedure, or

    • Ampicillin, 2g IM or IV 1 hour prior to dental procedure, or

    • Clindamycin, 600mg IM or IV 1 hour prior to dental procedure.


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