Dental Guidelines following Spine Surgery

Do patients with total joint replacements require antibiotic prophylaxis when undergoing
dental procedures to prevent prosthetic joint infection?

Guidelines from the American Academy of Orthopaedic Surgeons and the
American Dental Association state that antibiotic prophylaxis is not routinely
indicated for most dental patients with total joint replacements, although high-risk
patients undergoing higher-risk dental procedures may benefit from antibiotic

High-risk patients include:
1) All patients during the first two years following joint replacement.
2) Immunocompromised/immunosuppressed patients.
3) Patients with certain cormorbid conditions such as:
a) previous prosthetic joint infections
b) malnourishment
c) hemophilia,
d) HIV infection
e) type 1 diabetes
f) malignancy

Higher-risk dental procedures include:
1) Dental extractions.
2) Prophylactic cleaning of teeth or implants where bleeding is anticipated.
3) Periodontal procedures.
4) Root canal procedures.
5) Dental implant placement and reimplantation of avulsed teeth.
6) Intraligamentary and intraosseous local anesthetic injections.

High-risk patients with a total joint replacement undergoing a higher-risk dental
procedure should receive one of the following prophylactic regimens:
1) Amoxicillin or cephalexin 2 g orally one hour prior to dental procedure (if not allergic to penicillin)
2) Clindamycin 600 mg orally one hour prior to dental procedure.

The treating dentist will review the patient’s medical history, and determine the course of treatment.


American Dental Association; American Academy of Orthopaedic Surgeons. Antibiotic
Prophylaxis for Dental Patients with Total Joint Replacements (Advisory Statement).
JADA 2003; 134: 895-899.