Recently, a Washington Post commentator discussed the question of whether people with artificial limbs should take antibiotics before seeing the dentist. This had been a common practice for many years because it was believed that dental visits put people at risk for infections around their artificial joints.
But research indicates that dental visits are not associated with an increased risk of prosthetic joint infection (PJI). Instead, gum disease can increase this risk because everyday activities spread bacteria through your blood. Regular preventive dental visits are a good idea if you have prosthetic joints, because gum disease treatment can reduce your risk of PJI.
No Link Between Dental Visits and PJI
Last year, the American Dental Association (ADA) published updated guidelines about the use of preventive (prophylactic) antibiotics before dental visits. They found that there was no evidence to support the practice. An expert panel looked at previous analysis and at four recent studies on the subject.
In three of the four studies, there was no association between dental visits and PJI. In the fourth study, visiting the dentist more regularly reduced a patient’s risk of PJI. They acknowledged that this is a small number of studies, but the consistency among the various studies is great enough that they didn’t believe additional studies would change the outcome.
Because of the potential risks related to antibiotics, such as increasing antibiotic-resistant strains, they recommend that we stop the practice of preventive antibiotics.
Everyday Activities Put Bacteria in Your Blood
Doctors recommended preventive antibiotics because dental work increases the amount of bacteria in the blood. Bacteria in the blood colonizes the surface of replacement joints. Studies show this isn’t as significant as we thought.
Yes, dental treatments can lead to bacteremia–the release of bacteria into the blood. But so can tooth brushing, eating, and other activities that disturb the gum tissue. In fact, a study comparing the bacteria released into the blood after tooth brushing and tooth extraction showed that both led to increased bacteria in the blood 60 minutes later. Brushing hundreds of times a year was therefore considered a higher risk activity than an occasional dental procedure.
Gum Disease Treatment Lowers Joint Infection Risk
The true culprit in PJI is gum disease. The irritation caused by bacteria infecting your gums makes them more likely to bleed. Bleeding gums are an easier access point for bacteria.
Another study showed that treating gum disease lowered the risk of prosthetic knee infection. People who saw their dentist every six months for removal of tartar from their teeth had a 31% lower risk of prosthetic knee infection.
Protect Your Joints: See the Dentist
If you’ve had one or more joints replaced with a prosthetic joint, infection is a serious, but uncommon risk. You can lower your risk by seeing your dentist regularly (preferably every six months) for preventive treatment.