Q. Following a total knee replacement the orthopedic surgeon prescribed amoxicillin to be taken prior to any dental work. The other day when I picked up the refill at the drug store the pharmacist spoke with me about whether or not I should continue to take the antibiotic. He seemed to think this was no longer needed. On the other hand my dentist is of the opinion the medication is necessary and even cancelled one of my appointments because I forgot to take the pre-medication. I have dental appointments every 3 months for a procedure that is somewhat invasive due to a prior history of periodontal disease. My primary physician is the one that has been writing the renewals for the antibiotics. How do I go about finding out whether I should continue with the original recommendation?
A. The debate goes on as to a long standing protocol of prophylactic antibiotics for the prevention of total joint infections. One of the questions addressed in recent studies was whether dental procedures actually pose a risk to the prosthetic joint. After reading numerous articles on the subject it appears numerous medical organizations are tending to discontinue the recommendations of on-going use of antibiotics.
In your situation your dentist may have concerns about bacteremia being released into the blood stream following an invasive procedure. He may consider you to be at high risk of infection in light of your previous diagnosis of advanced gum disease. His approach may be one to err on the side of caution and believes the benefit outweighs the potential harm.
It is understandable you are confused about what you actually should be doing since you are getting mixed messages. One suggestion would be to ask if your dentist would be willing to have a discussion with your orthopedic surgeon and your primary care physician. It will be important for each of them to share information regarding your prior medical and oral health history so each one has all the facts. The outcome could either be they all agree medication should be taken prior to dental procedures or the controversy continues. In the event they do not come to a common conclusion you will have to make a decision based on the feedback you receive.
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