Houston Methodist. Leading Medicine

Hip FAQ

Question:

I have been struggling with overgrowth of yeast in my body ever since I had to take antibiotics repeatedly for ear infections. Now my dentist wants me to take another round of antibiotics before having my gums worked on. This is supposed to prevent a possible infection in my hip replacement. Do I really need this? What do you think?

Answer:

In the past, there has been a routine practice of prescribing prophylactic (preventive) antibiotics for patients with joint replacements having dental work done. The goal was to avoid infection, which can have serious complications for anyone with a joint replacement. Bacteria in the mouth can travel through the bloodstream and seems to have a preference for the joints. Once a joint with an implant is infected, serious damage and destruction can occur. Another surgery may be needed to clean the joint or even to remove and replace the implant. But as you probably already know, the overuse of antibiotics has resulted in stronger, more resistant bacteria called superbugs. And as you have experienced yourself, the destruction of the "good" bacteria in the gut from overuse of antibiotics has other consequences as well (e.g., overgrowth of yeast). Since only two per cent of the people who have hip, knee, or spine implants develop infections, there has been some concern raised. For example, should everyone with a joint replacement be on preventive antibiotics before having dental work done? Some studies are showing that dental procedures don't really increase the risk of infection. So the current recommendation is that each patient must be considered on a case-by-case basis. The challenge for your dentist is to figure out which patients are at increased risk for infection. More research is needed to see if taking prophylactic antibiotics reduces the chances of serious implant complications when certain risk factors are present. It may be that rates of bacterial infection vary depending on the dental procedure being done. For example, it would seem that pulling a tooth or more invasive procedures might have a higher risk rating. But some people develop infections just from flossing or brushing their teeth (or even chewing, which we do on a daily basis). Studies looking for individual risk factors (e.g., age, sex, number of dental procedures done) that might explain these differences have yielded contradictory results. Some researchers have looked into various types of antibiotics used to see if that might make a difference. Others have examined the use of different topical antimicrobials (mouth rinses) and how many times it is necessary to use them to prevent infection. Right now, there isn't enough conclusive evidence to recommend for or against the use of oral antimicrobials. With so much left unknown (inconclusive, indirect, or inadequate evidence), dentists must evaluate the risks and benefits of each dental procedure for individual patients who have joint replacements. Patients, physicians, and dentists must work together to come to an agreement about what is best for each one and plan treatment accordingly. You might want to ask your dentist to give you an idea of his or her thinking in your case. Let him or her know your situation and together work out a solution that is best for you. William Watters, III, MD, et al. Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. In Journal of the American Academy of Orthopaedic Surgeons. March 2013. Vol. 21. No. 3. Pp. 180-189.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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