Table 1. Patients at Potential Increased Risk of Hematogenous Total Joint Infection12,16-21

A. Immunocompromised/immunosupressed patients

Inflammatory arthropathies: rheumatoid arthritis, systemic lupus erythematosus
Disease, drug or radiation-induced immunosuppression
B. Other Patients

Insulin-dependent (Type 1) diabetes
First two years following joint placement
Previous prosthetic joint infections
Malnourishment
Hemophilia
Table 2. Incidence Stratification of Bacteremic Dental Procedures*

HIGHER INCIDENCE1

Dental extractions
Periodontal procedures including surgery, subgingival placement of antibiotic fibers/strips, scaling and root planing, 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

LOWER INCIDENCE2

Restorative dentistry3 (operative and prosthodontic) with/without retraction cord4
Local anesthetic injections (nonintraligamentary)
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

Prophylaxis should be considered for patients with total joint replacement that meet the criteria in Table 1. No other patients with orthopaedic implants should be considered for antibiotic prophylaxis prior to dental treatment/procedures.

Prophylaxis not indicated.

This includes restoration of carious (decayed) or missing teeth.

Clinical judgment may indicate antibiotic use in selected circumstances that may create significant bleeding.
*Adapted from: Prevention of Bacterial Endocarditis: Recommendations by the American Heart Association, from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young. Reprinted with permission of the Journal of the American Medical Association.22

Table 3. Suggested antibiotic prophylaxis regimens*

Patients not allergic to penicillin: cephalexin, cephradine or amoxicillin: 2 grams orally 1 hour prior to dental procedure.

Patients not allergic to penicillin and unable to take oral medications: cefazolin 1 gram or ampicillin 2 grams IM/IV 1 hour prior to the procedure.

Patients allergic to penicillin: clindamycin: 600 mg orally 1 hour prior to the dental procedure.

Patients allergic to penicillin and unable to take oral medications: clindamycin 600 mg IM/IV 1 hour prior to the procedure.

*No second doses are recommended for any of these dosing regimens.

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