July 01, 2018

After hip replacement, will I always need antibiotics before dental work?

Q: After I had hip replacement surgery 10 years ago, I was told to take an antibiotic before any dental procedure. Do I still need to do so?

A: Possibly not. It was previously recommended that all people who'd had joint replacement surgery take antibiotics before dental procedures to prevent infection. This recommendation, known as prophylactic antibiotics, was a broad recommendation that's no longer in place. In fact, the American Dental Association released guidelines in 2015 stating that, for most people, prophylactic antibiotics should not be recommended before dental procedures to prevent prosthetic joint infection. For most people, the risks of taking prophylactic antibiotics — including infection, allergies and the development of antibiotic resistance — may outweigh the benefits.

There are some caveats to that recommendation. In particular, people who are immunocompromised, have uncontrolled diabetes or a have a history of infection after joint replacement should take antibiotics before dental procedures. However, discuss this with your orthopedic surgeon or primary care doctor, who can help you weigh the risks and benefits.

While joint replacement may no longer be a reason to recommend antibiotics before dental work, there are other circumstances in which antibiotics may still be advised. If you're considered at high risk of infection in the inner lining of your heart chambers and valves (infective endocarditis), your cardiologist may prescribe an antibiotic before dental work. This includes people with prosthetic heart valves or a history of infective endocarditis, as well as people with certain congenital heart diseases. However, the current guidelines for this use also apply to fewer people than in the past, and may be worth revisiting with your doctor.

If prophylactic antibiotics are recommended, your doctor can provide a dosing regimen appropriate for you.