Position Statement on Antibiotic prophylaxis for Dental Patients with Total Joint Replacements
From the American Academy of Orthopedic Surgeons and the American Dental Association

Antibiotic prophylaxis should be considered only for the following patients when undergoing higher risk dental procedures as listed below:

• Inflammatory arthropathies, rheumatoid arthritis, systemic lupus erythematosis
• Disease, drug, or radiation induced immunosupression
• Insulin dependant (type 1) diabetics
• First two years following total joint replacement
• Previous prosthetic joint infection
• Malnourishment
• Hemophilia

Higher risk dental procedures for bacteremia:

• Dental extractions
  
• Periodontal procedures including surgery, subgingival placement of antibiotic fibers/strips, scaling and root planing, probing, recall maintenance
• Dental implant placement and re-implantation of avulsed teeth
• Endodontic (root canal) instrumentation or surgery beyond the apex
• Initial placement of orthodontic bands but not brackets
• Intraligamentary local anesthetic injections
• Prophylactic cleaning of teeth or implants where bleeding is anticipated

Suggested antibiotic prophylaxis regimens:

• Patients not allergic to penicillin: Amoxicillin, Cephalexin, or Cephradine:
  2 grams orally 1 hour prior to dental procedure
• Patients allergic to penicillin: Clindamycin:
  600mg orally 1 hour prior to dental procedure
• Patients not allergic to penicillin and unable to take oral medications: Cefazolin or Ampicillin:
  Cefazolin 1g. or ampicillin 2g. intramuscularly or intravenously 1 hour prior to the dental procedure
• Patients not allergic to penicillin and unable to take oral medications: Clindamycin:
  600mg intravenously 1 hour prior to the procedure

The decision to prescribe prophylactic antibiotics must of course be individualized for each patient. The above are guidelines and may not be applicable for every patient.