Dental treatment/hygienist after TKR

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After reading that at one time it was recommended that anyone who had a TKR should be covered on antibiotics for life when having hygienist work on their mouths or more invasive dental work, but then this wasn't recommended anymore because the overuse of antibiotics became such a problem, and then someone recommended antibiotics for the first three months after knee replacement because there was more blood flow to the knee in that period, it got me wondering.  Firstly, we're not really told the importance of dental hygiene especially if we have  TKR.  Having said that, it seems that it's not the bugs found in the mouth that seem to cause most knee infections!    So why were antibiotics being used at all?  IF someone was inclined to get bleeding when going to the dentist, then I wondered if it was worth them using something like the stronger corsodyl for a few days before going to the dentist to reduce any risk. 

It's one of these things with conflicting advice over the years, just like everything else!

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  • Posted

    The bacteria that inhabit our mouths are very numerous and normally not a problem. But certain of those organisms have a tendency to infect prosthetics...like heart valves and joints. There does seem to be changes with some doctors whether to continue antiotic prophylaxis for life or a shorter duration. I agree, antibiotic overuse is a problem. But at least in this instance it's a high one time dose just prior to dental or other invasive procedures. 

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  • Posted

    That's been an ongoing discussion on this forum. My. DDS AND surgeon say absolutely and use augmenton or keflex. Others so no need. The theory is metal is an attraction to infection and a y kind of dental work can be a quick opening to an infection so why risk it. Having had 2 staph infections, one creating the need to remove the prosthesis, my own opininon, if a couple pills will prevent a major problem....set em up, ill take it.

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  • Posted

    Hi, yes, have wondered the same thing recently. Especially as I have had trouble with some crowned teeth just after surgery. Had antibiotics and am maintaining a regime of extra cleaning etc but they will have to worked on at some point (9 weeks out). It concerned me as I had serious digestive bother from past abx and teeth troubles since I broke some in an accident. Also my knee has been super slow recovering movement and very swollen and painful, more so than other people I know, but check ups did not show any infection. And, as you say say there is little eveidence that dental infections really affect the knee very often.

    ?I wondered like you, why they ever gave them originally without any evidence and why if policy has changed, still a large % of tkr patients are being told to have abx during dental tment  for life or a set time?

    As someone who has been told a few times now that I am one of those folk in a tiny % who get this or that, I'm always a bit worried about anything with possible doubt. But I don't agree with overusing abx as there are already serious super bugs going around that threaten humankind.

    ?I've not reached a point where I am happy with my new knee so I do hope all this was worthwhile!

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    • Posted

      This is an interesting one!  I think I'll ask the hospital I'm using at some point.  I've got quite a few crowns and an implant.  I used to have gum issues because some of the crowns were badly fitted (that's another story!) but after getting them replaced and also changing my regime to using a tepe brush twice a day, electric toothbrush twice a day, flossing once a day and plaque reducing mouthwash twice a day, I've now got the score of 0 on gums - no problems, but I am wondering just when to get my next check (three months after knee replacement????) and whether to get cover of antibiotics.  I don't normally get any bleeding with a check up or the hygienist, so does that mean no risk?  I don't know!

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    • Posted

      Hi Chris

      Yup dentist won't do any work or allow teeth to be cleaned without high antibiotics few hours prior .

      I hate it since I take supplements and eat healthy and rarely even get a cold . Have strived hard to stay healthy to avoid those very drugs ! But I'm taking them .

      Figure too I am taking extra good care of teeth to avoid needing to go in much .

      I guess if it's even remotely possible to get the knee infected I'll change my mindset just for dentist , don't want go through infected knee ever .

      Debbie

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    • Posted

      Ah!  Are you in the UK Debbie?  I guess this is something I need to ask my dentist before I go for a check up and clean!  He's put me on to yearly visits but now wondering if I should go six monthly or whether yearly is better.  Oh heck - lost!

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    • Posted

      Ah - I wonder if there are different policies in the US to the UK.  Is anyone in the UK having antibiotics for routine dentals?  Although, having siad that, I'm pretty sure I read that it was in the American one too, not to give them routinely now, so maybe it's just different dentists.

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  • Posted

    We covered this in another thread a while ago.  The new 2016 guidelines from the ADA do NOT recommend antibiotics except in certain cases for people who have a variety of other conditions.  All dentists should be up on these new guidelines.  You can Google them yourself.
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    • Posted

      “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.” - ADA

      According to the ADA Chairside Guide, for patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, "prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon; in cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and, when reasonable, write the prescription." - ADA

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    • Posted

      Yes, this is what I'd read - that this was the latest advice, although some still seemed to say use them for the first three months after TKR.  But my question was if no antibiotics were going to be used, would it be a good idea to use something like the stronger corsodyl that would reduce the bugs in the mouth, for five days before a dental appointment.  I do believe the risk from dentals is lower than other risks though, and take into account the overuse of antibiotics generally, then corsodyl might just cover that?

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    • Posted

      Corsodyl is really for help in treating gingivitis & minor periodontitis. It really should be used as advised by your GDP. It isn't a prophylactic.

      Chlorhexidine is a disinfectant & antiseptic but I wouldn't advise using it as a prophylactic without discussing it with your GDP. It can cause tooth discolouration & skin irritation.

      Speak to your GDP (dentist) first.

      Marilyn

      XX

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    • Posted

      Ah, will do Marilyn!:-))))  Thank you:-)))))  I only used it for five days before the op but will ask the dentist.  I suspect he's going to say my teeth are so clean and gums so good that I don't need to, but I will ask before the next knee is done:-)))))  I just felt with the hospital giving me the Hibiscrub (I wonder if everyone is given that - that's a good question!) then 'the weak link' might be the mouth.  Back to the sheep dip:-))))

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