The Six-Month Mark and First Rounds of Antibiotic Pre-Treatments


Tomorrow (July 12) marks the six-month anniversary of my right total knee replacement (RTKR). I’ve come a long way from barely being able to put on socks and shoes a few days after surgery to walking all over town on errands without pain! I keep asking myself “Why didn’t I do this earlier?”

My next orthopedist appointment is in September, which will likely involve not only checking progress of my right knee but also making preparations for surgery on my left one, which brings me to today’s topic.

I wrote a blog post in early March about whether or not antibiotic pre-treatment prior to dental or surgical procedures was necessary following joint replacement surgery.

When I went for a six-month dental checkup July 1, the first question asked was if I’d taken the prescribed Amoxicillin (2,000mg) an hour prior to my appointment and had to sign a form verifying I did the pre-treat.

Yesterday was the second time I had to do an Amoxicillin pre-treatment; one tooth had a horizontal split to its root and needed removed. With the root position at a difficult angle, my dentist couldn’t extract it in her office without risk of further complications. I was referred to an oral surgeon – who popped out the damaged tooth without problems (it seemed to take longer for the local anesthetic to take effect than the oral surgeon to remove my tooth!).

The diagram below will give readers a general ideal what I dealt with for almost 12 days before the broken tooth was removed (notice the “Nontreatable Tooth” split all the way to its root):


“Why is an antibiotic pre-treat necessary?” you may ask. “My orthopedic surgeon thinks I’ll do fine without it.”

Some people can get along without pre-treatment, but I’m not one of them. Not only do I have a knee replacement (soon to be two), but also conditions known as mitral regurgitation and tricuspid regurgitation (albeit milder forms). Any surgical or dental work needed requires antibiotic pre-treatment an hour prior to any procedures – including simple teeth cleaning – for the rest of my life.

There’s no question bacteria is alive and well in our mouths. No matter how much brushing, flossing, mouthwash use or other types of dental hygiene are done, germs will somehow survive and multiply. Some joint replacement patients can do without pre-treatment, provided other medical issues (such as cardiac problems or diabetes) are either absent or proven not to be affected by lack of antibiotic coverage. Any concerns should be discussed with your doctor or dentist, as their opinions may vary.

Before the use of antibiotics can be recommended routinely before dental treatment, the following questions should be asked to determine whether or not you’d need antibiotic protection:

Can bacteria enter my bloodstream from dental/surgical procedures?

Can my orthopedic implants become infected from specific sources (such as tooth extractions)?

Can antibiotic treatment lessen the chance of bacteria reaching my artificial joint and reduce chances of infection(s)?

What are the risks of pre-treatment?

You can read more on antibiotic treatment in the Johns Hopkins Antibiotic Guidelines 2014-15 Manual. to assist in making an informed decision with your medical professional.


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