April 8, 2020
link to facebook link to twitter
More Stories
Fear of losing loved ones may keep families from planning The better angels of our nature today Covid-19 and churches shaking hands? “Do this for me”: How to convince older loved ones to socially distance When hard things happen What the Coronavirus is teaching us The spirit of Alzheimer’s learning Part II Coronavirus, taking life for granted Halloween pirate’s gold Fall risks are sometimes simple, yet fatal Is multi-generational living for you? Five tips to prepare for and reduce risk of illness in older adults Natural disaster threats call for preparedness plan to protect seniors The spirit of Alzheimer’s learning  Winter sun safety: What to know about protecting yourself during colder months Tending to spiritual distress with aging and illness Blood pressure control a focus of American Heart month Home your own way March is colorectal cancer awareness month Safety at home for seniors Prepareness plan to protect seniors Rain is expected this week in NorCal, and I love gazing at it How to prevent bad breath War on opioids in California Help families make time for seniors during the holiday season Helping seniors with vision and hearing impairments Holiday stress-busters for harried caregivers It’s what’s inside that counts! Dental emergencies Don’t wait until it hurts! Does spring mean allergy season for you? Top 10 products to help seniors stay home How to take Tylenol safely The role companionship plays in aging 7 Tips to reduce the stress of incontinence caregiving Five best pet types for seniors Time for the yearly flu vaccine The state of Alzheimer’s and caregiving in the U.S. Who will decide your death? Improving the state of aging in America Fight flu this season by getting immunized Confirm your preparedness plans for Seniors Did you get your flu shot? If not why not? A message from the heart Using anxiety to your advantage Youth, women and dementia The long-reaching impact of dementia Children’s dental health month Ten tips for healthy aging Planning for aging at home Thirty-four years as a dentist Tooth friendly Easter tips Feeding my hungry heart How to keep older adults cool during the heat of the day Invisible braces work wonders Avoiding spooky smiles this Halloween How to keep an aging adult’s blood pressure in the green zone Mother's gum disease linked to infant’s death Giving thanks The increasingly important role of caregivers Ten things you can do now to protect your five senses as you age Wonder what it’s like to lose your senses? The difference between seasonal flu and a pandemic respiratory virus Senate passes Alzheimer’s and dementia research funding October’s most celebrated event Our Feelings Come From Our Beliefs Making sense of the season for seniors Cultures differ on what makes a beautiful smile! How to have a better year Falling in love is easy, but staying in love is very special A confession Women in dentistry Plan for where you want to age Three ways a senior can fund a home remodel Cannabis as medicine-Changing the face of aging May is skin cancer awareness month A brain is a reason to join the Alzheimer’s fight Recognizing and reporting elder abuse Dental technology- computers have changed our lives Create your personal Medicare account Understanding the aging brain Two ways to get your Medicare taken care of Are you stressed out? Seven ways seniors can interact with pets The joy of root canal therapy Lung cancer screening helps combat the #1 cancer killer in the nation Simple happiness hacks for caregivers Multiple sclerosis, an autoimmune disease Seniors and Diabetes What you need to know Let’s talk about guilt and the emotional journey of being a caregiver The wonders of a growth mindset Dealing with emotional storms Dealing with disappointment How to know if you are in danger of compression fractures Psychology Today The Art of Resilience: I Have I Am…I Can The advantage of dental implants Too much of a good thing for seniors and the holidays What families’ caregivers need to know about Recommendations for screen time Resolutions for your oral health Super Bowl, Joe Montana and blood pressure Open heart surgery – Thoughts from the other side Chewing gum - Helpful or harmful? Five tips for a healthy smile I will– I should– I can– I’ll try Rightsizing for seniors doesn’t have to be painful The Joy of Sadness Human Touch: The role companionship plays in aging at home Becoming who we really want to be How to fail well Back to school with healthy teeth Five ways to manage caregiver guilt Senior dating – Mom’s new relationship is heating up... Should you be concerned? Aspirin relieves mild pain Fighting osteoporosis and preventing fall-related injuries Pets and seniors make the perfect pair Turn the page Anxiety: The real reason Mom won’t leave the house My prostate and thyroid cancer Oral piercings and your teeth Understanding senior care options Staying well and safe for the holidays Health habits for the new year New Year, new you: Practicing active aging in 2020 Spotting the signs of Alzheimer’s disease Sniffles and sneezes and fevers, oh my... The risk of isolation and loneliness from hearing loss Healthcare - this feeling has to change Un-retiring in a changing economy Coping with the unpredictable life of caregiving Double duty tools: toothbrush and floss Merry Christmas and Happy New Year Tips for living with low vision  Keep your Medicare costs down The freedom and choice to again place at home Put dementia on the agenda for 2019 Free app shows what Medicare covers The reason “Four” is the magic number? Preventing tooth decay in children Laughter is the best medicine Sports mouth guards-keeping teeth safe  Help your senior loved one avoid preventable hospitalizations Tips for keeping calm in the midst of crisis  Five cybersecurity tips for older adults Preparing kids for first dental visits Dental treatment concerns with patients taking blood thinners Home Health Care vs. In-Home Care: What you need to know Three ways to lessen negative thinking Five ways our self-talk may be hurtful Is this Summer or Fall What can you do to help dad control his blood pressure? By this time you have learned... whether you’re 14 or 84… Controlling your holidays Your Medicare costs in 2020 Mind your mind Hints for a better life When we’re haunted by regret, we all have regrets. Some surprising discoveries on being optimistic Valentine’s Day befuddling First dental visit – Make it a good one! Unusual connection between your sense of taste and risk for disease Amazing results with Arestin Navigating the aging journey Smoke and stress maintenance and recovery How to lower your surgery costs Know your pharmacist… Know your medicine as drug prices will jump in 2019 Influenza activity is increasing throughout California Show your kids’ teeth some love this Valentine’s Day! New life and stormy weather Your Medicare rights and protections Summer snacking and your child’s teeth Back to basics 10 summertime activities for seniors Three ways to boost your self-esteem Increasing West Nile Virus activity in Ca. Why are seniors targets for scams? Summer’s sun damages the skin Abscess gives warning 8 tips to minimize the behaviors of “Sundowning” Keeping your relationships fresh What are dental sealants? Suicide - Are there answers? Nothing is impossible Becoming optimistic in a chaotic world Entitlements - more money Your best Christmas gift? Suicide a growing epidemic What family caregivers need to know about Medicare changes Should you quit? Steps to help minimize wandering behavioral symptoms The Groundhog’s last plane ride Are you making yourself understood? Healthy eating habits can benefit you and your teeth How does the body heal? Apply or renew Covered Ca. Health insurance by Jan. 15 Guilt from holiday eating Toothbrush tips Three reasons for a root canal Seniors: Say no to “free” genetic tests Yoga for relaxation & healing What causes sensitive teeth to hurt All of us make mistakes  Heat and older adults Five tips to cope with caregiver anger Back to school health Real decisions and moderation Conscious Sedation Dentistry– No fear! Still time to change your Medicare health plan Dental emergencies can happen What Medicare does (and doesn’t) cover Weinstein, Sanders, Trump pleasing people? Three gifts you can give yourself Don’t stress, clench or grind! Gratitude and positivity can inspire caregiver self-care Medicare helps seniors use opioids safely Is it elder abuse or neglect? Dental scanning technology improves dental care Using Medicare when on foreign land I slept in last Saturday! Always being bright may not be so bright Trying to save a knocked out permanent tooth Reduce senior fall risk Are glasses enough? Spotting common vision problems in older adults Kobe - preparing for shocking death What happens to our teeth and gums as we age? Reduce wear and tear As Autumn begins, a reminder flu season can hit seniors hard Overcoming fears surrounding End-of-Life care Important: women and periodontal health Americans unaware of potentially life-threatening skin cancer Sun protection tips for young children Some good news! Aging gracefully Cannabis symposium Sept. 19th The importance of immunization Returning home is bittersweet Kids who grind their teeth at night Osteoporosis, osteonecrosis and dental health Living with Lupus Erythematosus Still time to change your Medicare health plan How dentistry handles gastric reflux disease Use it or lose it- Muscle mass as you age  A free cheek swab test Twice a victim Finding a path forward after an accident Use it or lose it- Muscle mass as you age  If it is not broken, don’t fix it! Managing your mental health with or without insurance coverage Why gardening is the most recommended exercise for seniors

Prosthetic joints and dentistry

By: George Malkemus
October 4, 2019

Antibiotics are not needed before dental treatment for patients with prosthetics.

Joint replacement

 A joint replacement involves the removal of a damaged joint that is replaced with an artificial joint, called prosthesis. Seventy percent of joint replacements are performed because arthritis has caused the joint to stiffen and become painful to the point that normal daily activities are no longer possible. If the joint does not respond to conservative treatment like medication, weight loss, activity restriction and use of walking aids such as a cane, joint replacement is considered appropriate and necessary.

The most common joints that are replaced are hips and knees. Over one million Americans have successful hip or knee replacement surgery each year.  There is ongoing work on elbow, shoulder and ankle replacement.  Joint replacement has a long history.  Total hip replacements date back to the 1700s. Today hip and knee replacements are highly successful due to improved and less invasive surgery techniques and the improvement in material components, in particular the metal titanium that replaced stainless steel.  Titanium has an amazing biocompatible feature; bone actually grows into the metal and fuses to the titanium implant.  Dental implants are also made out of titanium. The jawbone fuses to the dental implant root replacement.  

Infections in joint replacements 

Infections have always been a problem with joint replacement surgery.  During the 1950s, the infection rate after hip joint replacement surgery was close to 12 percent.  By the 1970s, the rate of infection after hip surgery had been reduced to less than two percent.  The reduction was due to two important changes: 1) treatment with antibiotics just before the hip joint replacement surgery and 2) the use of laminar airflow systems in the operating room. This reduced the most common post-operative infections in the prosthetic joints, which occur during the first three months after surgery and are caused by wound contamination in the operating room.   Infections that occur after three months are less common and thought to be caused by either wound contamination or the spread of bacteria through the blood circulatory system from an infected site in another part other body. One possible source of infection comes from the mouth through the gums. 

Periodontal disease and joint infections

Gum disease, called periodontal disease, plays a role in numerous disease conditions throughout the body including heart disease, strokes, ulcers and adverse pregnancy outcomes such as low birth weight and preterm births. Diabetes is also affected and increased by periodontal disease, which alters blood sugar control in diabetics.  Bacteria that build up between the tooth and gum can enter into the bloodstream when gums bleed. These bacteria can travel throughout the body and cause serious health problems. Also, periodontal disease is an inflammatory disease and affects other diseases that are affected by inflammation such as diabetes.

Since the 1970s, there has been concern that the source of the late infection in prosthetic joints was coming from periodontal disease. To prevent this possibility, antibiotics were given to prosthetic joint patients before dental treatment. Taking antibiotics before any medical or dental treatment is called antibiotic prophylaxis.  The theory was that bacteria found in bleeding, infected gums traveled from the mouth, through the blood stream to the prosthetic joint, where circulation is reduced and then eddied out in the joint area and started an infection. It was thought that taking antibiotics would prevent this from happening. Though there was no scientific basis for this theory, giving antibiotics before dental treatment to patients who had prosthetic joints became the norm during the 1980s and 1990s. During this time antibiotics were given routinely even for dental patients with metal pins, plates, and screws, and also even for prosthesis without metal, including breast implants. 

Subsequent studies have shown that antibiotic prophylaxis is not usually needed for most dental patients.  Prosthetic infections are almost exclusively caused by staphylococci.  These bacteria are not found in the mouth.  Also, individuals with periodontal disease are at a continual risk for infection spread, not just when they see the dentist. What is important is for all individuals to keep their gums in good health.   

Extensive evaluation of evidence-based studies has concluded that even high-risk dental procedures performed within six months to two years of prosthetic hip or knee procedure were not associated with increased risk of prosthetic infection compared to no dental procedures.   They also show that antibiotic prophylaxis did not decrease the risk of infection. 

Statistical research has shown that there is a much greater risk of allergic anaphylactic shock from antibiotic use than there is risk of prosthetic infection during a dental procedure.  Finally, bacteria resistance has become a concern with antibiotic over use. 

2003 guideline changes

In 2003, new guidelines were designed by a collaboration of the Infectious Diseases Society of America [IDSA], the America Dental Association [ADA] and the American Academy of Orthopedic Surgeons [AAOS]. 2003 guidelines state, “The risk/benefit and cost/effectiveness ratios fail to justify the administration of routine antibiotic prophylaxis.” 

According to the guidelines, “antibiotic prophylaxis was not recommended for patients with pins, plates or screws, or for otherwise healthy patients with total joint replacements.  Patients at greater risk due to specific medical conditions should be considered candidates for prophylaxis.  These included patients whose prostheses were less than two years old or those who had ‘high-risk’ conditions such as inflammatory arthropathies [rheumatoid arthritis, systemic lupus erythematosus], drug-induced or radiation-induced immunosuppression, previous joint infection, malnourishment, hemophilia, human immunodeficiency virus infection, insulin-dependent diabetes or malignancy.”

Present ADA Guidelines and Conclusions from 2015 

There is evidence that dental procedures are not associated with prosthetic joint implant infections.

There is evidence that antibiotics provided before oral care do not prevent prosthetic join implant infections.

There are potential harm of antibiotics including anaphylaxis, antibiotic resistance and opportunistic infection like C difficile.

The benefits of antibiotic prophylaxis may not exceed the harms for most patients.

Given this information in conjunction with the potential harm from antibiotic use, using antibiotics before dental procedures is not recommended to prevent prosthetic joint implant infection.

The individual patient’s circumstances and preferences should be considered when deciding whether to prescribe antibiotics prior to dental procedures.

Basically the 2015 guidelines say that there is no evidence showing dental treatment causing prosthetic implant infection, and antibiotic use is not recommended.

Most prosthetic patients do not need to take antibiotics before dental treatment.

 The most important recommendation is to keep one’s gums in good health.  Periodontal disease can be prevented with good oral health habits, such as brushing and flossing, and regular professional cleanings.


Enjoy Life and Keep Smiling!


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at