Dental Therapy Protocol

Management of Patients with Orthopedic Implants Undergoing Dental Procedures

All patients who have received an orthopedic implant (total joint replacement) within 3 months of surgery are to be given prophylactic antibiotics prior to dental procedures that involve manipulation of gingival tissues or perforation of the oral mucosa. It is in the physician’s opinion these recently placed implants may be more susceptible to bacteremia due to the acute inflammation of the arthroplasty procedure and the presence of resolving seromas and hematomas at the surgical site.

Beyond 3 months, please follow the American Academy of Orthopedic Surgeon’s (AAOS) OrthoGuidelines for the “Management of Patients with Orthopedic Implants Undergoing Dental Procedures”. Please give close attention to the defined criteria for the immunocompromised patient. These guidelines are found at: www.orthoguidelines.org/go/auc/

All antibiotics are to be given 30 to 45 minutes prior to the procedure.

Antibiotic options for adults not allergic to penicillin or ampicillin:

  • Amoxicillin 2 grams oral
  • Ampicillin 2 grams IM or IV
  • Ceftriaxone 1-gram IM or IV

Antibiotic options for adults ALLERGIC to penicillin or ampicillin:

  • Cephalexin 2 grams oral
  • Azithromycin 500 mg. oral
  • Clarithromycin 500 mg. oral
  • Ceftriaxone 1-gram IM or IV