💊 Post-Operative Antibiotic Prophylaxis Guidelines

From: Dr. Jeffrey Wilde, MD - Scripps Clinic

Phone: (858) 554-7993

2 Years of Antibiotic Prophylaxis After Total Joint Replacement

For protection against the remote possibility of blood-borne bacteria, carried from the mouth during a dental procedure, creating an infection in a total joint replacement, a combined task force of American Academy of Orthopaedic Surgeons and the American Dental Association has made the following guideline recommendations:

🚫 Critical Restriction

No dental visits for 3 months after surgery unless it is an emergency

For Jeff's surgery on September 12, 2025: No routine dental care until December 12, 2025

1. Standard Prophylaxis Requirements (2 Years)

Following total joint replacement, all patients are advised to take an antibiotic regimen for 2 years when undergoing dental procedures such as:

  • Prophylactic cleaning of teeth or implants
  • Intraligamentary local anesthetic injections
  • Periodontal procedures
  • Root canal procedures
  • Dental extractions
  • Dental implant procedures
  • Implantation of avulsed teeth
  • Initial placement of orthodontic bands

2. Lifetime Antibiotic Prophylaxis

Lifetime antibiotic prophylaxis for dental procedures is recommended for patients considered at higher risk:

  • Solid organ transplant
  • Rheumatoid arthritis and other rheumatologic conditions affecting the immune system
  • Diabetics
  • Smokers
  • Chronic renal disease
  • BMI >40
  • Patients taking disease modifying anti-rheumatic drugs, biologics, steroids, or chemotherapy

3. Standard Antibiotic Regimen

If not allergic to penicillin:

  • Amoxicillin, Cephalexin (e.g. Keflex), or Cephradine
  • Dosage: 2.0 grams orally
  • Timing: 1 hour prior to the dental procedure

4. Penicillin Allergy Alternative

For patients with a penicillin allergy:

  • Doxycycline (e.g. Vibramycin) 100 mg, OR
  • Azithromycin (e.g. Zithromax) 500 mg
  • Timing: 1 hour prior to the dental procedure

5. Getting Prescriptions

Call your surgeon's office when you will be going to the dentist to receive an antibiotic prescription, or your dentist may also prescribe an antibiotic for you.

Emergency Dental Care

If you have a dental emergency, call both: