Is Dental Clearance Required before a Knee Replacement?

Posted by dmjohnstone @dmjohnstone, Jan 7, 2023

Is it require to have a dental clearance before knee replacement?

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Profile picture for runningy @runningy

I had a TKR about 2 1/2 years ago and received somewhat conflicting advice going forward. The surgeon wanted me to take antibiotics before every dental cleaning or procedure where bacteria might enter the bloodstream and migrate to the knee. My dentist, on the other hand, did not think it was necessary. I've been cautious, perhaps overly cautious, so I do take antibiotics before each dental cleaning, but will probably stop now. You take the antibiotic a day before or the day of your dental procedure. Talk to your orthopedic surgeon and your dentist and get their advice if you haven't already. You (and I) are in an area where there isn't 100% agreement by the medical folks. I don't know why you would need to cancel needed dental treatment now as you probably had antibiotics post surgery and could take another course before a needed dental procedure. Good luck going forward.

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@runningy my surgeon’s nurse at first would not let me go. She called me back said I could go. She put in a prescription for amoxicillin 500 mg for tablets one hour before the procedure. My Doctor dentist said no it’s only X-rays. No need and there’s not enough evidence to back this up and you don’t want to build up an immune system to them. I took the pills. Glad I did because right after the X-rays he went in with the poking tool. Even though the dentist said only X-rays.
It’s so frustrating. Thank you for sharing and responding. I feel better knowing I’m not along. Not because I want people to go through this. Thank you again.

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Profile picture for jemh44 @jemh44

@vtanderson thank you so much. The nurse insisted she told me. Funny thing is I never saw her before my operation. Only the Dr and the last who made my knee appointment. I understand they deal with a lot of people and probably say a lot of things, but they really didn’t tell me. Now I do have something going on. They’re not sure. Dentist will see me on Tuesday. I have this paste to put on the area. No antibiotics. Only the 4 I took before the procedure and I have to take four more antibiotics before my procedure on Tuesday one hour. I too will be on antibiotics for at least a yr or more I have an autoimmune w celiac. Thank you for not judging me 😊

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@jemh44 My surgeon’s team gave me clearance forms for both my GP and dentist to sign. Along with written directions that if they were not completed 2 weeks prior my surgery would be canceled. This way there is no misunderstanding or forgetting to inform the patient. I am so sorry this happened to you and pray that there is no infection in your knee. Keep us posted on your progress.

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Profile picture for vtanderson @vtanderson

@jemh44 My surgeon’s team gave me clearance forms for both my GP and dentist to sign. Along with written directions that if they were not completed 2 weeks prior my surgery would be canceled. This way there is no misunderstanding or forgetting to inform the patient. I am so sorry this happened to you and pray that there is no infection in your knee. Keep us posted on your progress.

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@vtanderson thank you for the prayers. I hope this makes sense when I say this, the Doctor Who did my knee was really good. I absolutely have no problems with my knee. It’s my thigh and shin. OM!!! The pain in my thigh from the tourniquet he used. I also got a nerve block and a spinal shot. I think it’s called an epidural. I did not know about the tourniquet until after I had the surgery. I started talking to mature people who have had their knees done and I was told they never had a tourniquet. I am black and purple from the tourniquet I didn’t even know someone could be this black and purple there’s no blue no yellow. Completely black and purple. My leg looks dead. I am having a hard time healing because my thigh muscle feels as if it was crushed which it was crushed an my nerves spazzing hurts. I can’t get my brain to tell my thigh muscles to contract because they feel dead. If that makes sense they’re not alive. I don’t know if anyone has had this problem using a tourniquet because everyone I spoke to never had a tourniquet used on them. when I go to get my right knee done I am going to ask if he has to use the tourniquet if he says yes, then I will go someplace else. I will go to Beth Israel, I don’t have much time to make decisions. I saw the Dr and was in surgery a week later. It had to be rushed.
I still wouldn’t have known to ask about a tourniquet even if I had time or perhaps I would have research total knee replacement if I had the time because that’s what I usually do when I need something done. My opinion from what I went through, I would NEVER do a tourniquet EVER again. Besides my knee being great the communication was bad. It’s good your Dr gave you papers and told you what to do. I think Dr’s should have on their websites a place where the PT can go to a drop down box find the procedure they are having and have ALL the info we need for before/After the procedure. After reading it we can sign it if the Doctors want to cover themselves and we can print a copy or when we come into the office to go over everything the secretary can print it for us to ask questions. I don’t know, my opinion. Thank you for the prayer. I will let you know once I find out. I’m glad I found this connection some of the people who have responded have been so kind to me. I’ve never joined a support group before. Mostly because of the scary stories. Even with my husbands young onset Parkinson’s I had to stay away from them. Too much for me. Here has been a blessing for me. People have been great. I appreciate the kindness. 😊

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Profile picture for jemh44 @jemh44

@ddsack thank you so much for replying. My surgeons nurse at first would not clear me. Being honest I said ok so if I have an infection & something happens it’s on you. She called me back gave me a prescription of antibiotics amoxicillin w tablets one hour before the procedure. X-rays and poking was done. I have raw gums from the 22 hours of vomiting after the surgery. My acid is really high gums are receding. I have a paste to put on them and another appt on Tuesday with another Dr to discuss and do more tests.
Thank you so much. I got so nervous from reading about people getting infections in their knee from their mouth. I panicked. You also said what my Dad told me. Small percentage. Thank you so much.

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@jemh44
I’m glad you got the antibiotics, sounds like you have a lot of uncomfortable things going on! I hope you can get some answers from your next appointments, be sure you ask a lot of questions if you don’t understand at first. Some doctors are wonderful at explaining in layman’s terms, and some just want to throw technical jargon at you to awe you into acceptance of what they say. Don’t let them leave the room until you are clear on what’s going on and what your next step needs to be.

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