Is Dental Clearance Required before a Knee Replacement?

Hello @dmjohnstone, Welcome to Connect. My Mayo Clinic surgeon didn't require me to get a dental clearance before I had my right knee replacement surgery. I think it depends on who is doing the surgery. Here's some information from Dec 2019.

"Conclusion:
With an aging population, the number of total joint arthroplasties is likely to continue growing. Periprosthetic infection remains a great concern and quality improvement problem despite improvements in sterile and prophylactic techniques. There is little evidence to support universal dental clearance before TJA, even for higher risk patients. There remains a need for future research to elucidate the mechanism of periprosthetic infections and more robust analysis of patients with high risk dental pathologies to help guide interventions."
-- Impact of dental clearance on total joint arthroplasty: A systematic review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937426/
Is your surgeon requesting a dental clearance before doing your knee replacement?

Not that i know of. My surgery is feb 10 . I will be doing pre op appointments on 26th of this month so i will find out. Ty for the information

Before/after my recent TKRs, no clearance was required. However, my surgeon directed for that a certain time period before, and then after, surgeries no dental work be done without an antibiotic they would prescribe. Just check with your surgical team or nurse navigator.

I don’t write this to scare anyone just share my life story. I had my second TKR about a year an a half ago. I had my semi-annual dental appointment approximately a month before my surgery. They did not do X-rays. First week after surgery a tooth broke & part of old filling came out; I discussed situation with my Surgeon. He was very concerned about the possibility of infection or abscess sending infection to new TKR. Usually they don’t want you to have dental work for approximately three months after TKR. It was a lot of discussion between me my dentist and my surgeon. It was two weeks of great tension for me. Finally found a Dentist that was willing to do the repair. It was risky no matter what I chose to do. Everything worked out well, thank you Lord! I freely admit that I am more concerned about TKR infection than most people. Probably because my Dad was one of the rare cases that didn’t work out as they usually do. My Dad had a TKR on his right leg and six months later was forced, because of pain he was forced have right hip replacement. Rehab was taking longer in the hospital than with the TKR. Dad had mentioned to me that he was having pain behind the TKR. I mentioned to the staff. He had also developed a blister on the same leg, another big warning sign. A few days later they sent him to a rehab center. That had a flu outbreak there a couple of days later. Dad started running a temp. They diagnosed the flu. A day later they had to rush him to ER. They did an x-ray noticed a little heat and pinkness around TKR and we’re about to sent him back to Rehab Center. I asked for blood work to be done before they sent him back. Later found out I should have asked for blood culture instead. Three days later he was home with his Lord. So I would personally recommend everyone to have Dental exam with x-rays before any replacement. I would not want anyone to go through what I have endured. Please understand from my research what happened to my Dad and myself were rarities but as been said “An ounce of prevention is worth a pound of cure”. May God watch over you and protect you as you have you have your surgery.

I am 3wk 2 days post TKR. In 52 and didn’t know anything about dental work. No one told me. Now I have a gum infection with a tooth I’ve been having problems with. All my dental appts I canceled after finding out from a friend I can’t get work done. As of today I got clearance to get X-rays done to see what’s going on. I’m so scared. I really don’t want an infection and go through another operation on my knee because of infection. I was also made to feel as if I should have known this information. I’m a smart educated woman. If I did know I would have done the right thing. Now I feel stupid and judged because people don’t know I didn’t know. I’m so nervous about tomorrow. I had to vent on a place where I don’t think I’ll get judged. Thank you

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.

@jemh44 No one plans or chooses when they might have a dental problem, so you shouldn’t feel judged. If there is already an infection, you need to get it taken care of, both for your own comfort and to get it out of your body. I would call your surgeon/doctor’s office and tell them your situation. It may be that they might prescribe a stronger and longer form of antibiotic to start taking due to your TKR being so recent. The dentist can also prescribe antibiotics, but you might want the surgeon’s opinion. The actual chances of getting an infection from a dental procedure are pretty small, so don’t panic.

@jemh44 Don’t feel bad. How would you have known if the surgeon did not tell you? My surgeon required a dental clearance prior to surgery. I understand this varies from surgeon to surgeon and hospital/surgical center to hospital/surgical center. I hope you are being treated for the dental infection. My surgeon and dentist also want me on antibiotics prior to dental work as a precaution for 1 year post op. This also varies with providers.

@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 😊

@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.