PRE MED, higher education for orthopedic patients


PRE MED, higher education for orthopedic patients

We have many patients with joint replacements who ask us, “Do I need to take an antibiotic prior to my cleaning?”

Pre Med in this case is not the course work, but the course of action advised or assumed by patients who have had orthopedic implants. Dr. Martin promotes a collaborative decision between the patient, the physician and the dentist. Patients should engage in the decision making process as they gain information from the orthopedic physician regarding the risks and benefits to taking preventive antibiotics prior to dental treatment.

Patients who have a joint replacement, metal plates or rods from orthopedic surgery ask, “Should I take antibiotics before my dental procedure? “

  • Potentially, 1-3 % of implants result in bacterial infection, most of which occur within a year of the procedure, which could result in more surgery.
  • Although there is no clear evidence, some theories indicate late implant infections are caused by the spread of bacteria to the implant from the bloodstream. We know many patients frequently have bacteria in their blood that does not spread to their implant.
  • While dental procedures have been considered a potential cause of implant infections, it is important to realize that not only dental procedures can introduce bacteria, but the simple daily routine of eating and brushing at home may also introduce bacteria into the blood.
  • Traditionally, antibiotics are often prescribed by the orthopedic doctor to minimize bacteria into the bloodstream. However, the best evidence does not show that antibiotics (premed) provided before oral care prevents orthopedic implant infections.
  • The routine use of antibiotics has potential side effects such as increased bacterial resistance, allergic reactions, and diarrhea and may even cause death. PATIENTS WITH A COMPROMISED IMMUNE SYSTEM MIGHT BE AT GREATER RISK FOR INFECTION.
  • Diabetes, rheumatoid arthritis, cancer, chemotherapy and chronic steroid use are examples of conditions that should be discussed with your physician and dentist regarding antibiotic use. These patients may want to consider pre medicating with antibiotics with their greater risk of infection.
  • Decisions to use antibiotic premedication should be an informed decision by the patient, dentist, and physician with open communication and informed consent.


Text is adapted from the Shared Decision Making Tool:  An Aid to Help Balance Clinical Information and Treatment Options with Patient Preferences authored by David S. Jevsevar, MD., M.B. A.