Why must I take antibiotics before seeing the dentist if I have an implant?

If you've had an implant, it's essential that you take antibiotics before you go to the dentist. Reputable dentists won't work on you if they know you've had an implant (including a hip replacement) and refuse antibiotics. During dental procedures, the tens of thousands of bacteria living in your mouth can spread into your blood and lodge on the surface of artificial things, such as a knee, heart valve, or hip replacement. Some of these newer replacement parts have antibiotics embedded, but you still need antibiotics for a dental procedure.

The immune system can't see bacteria resting on inorganic (ceramic, metal, or plastic) implants, so no white blood cells come to attack and kill them off. As a result, if you have an implant and don't take antibiotics before going to the dentist, harmful bacteria thrive and you can get a whopper of an infection. Also, if you have a hip replacement, over time a bacterial film can build up in and around the hip replacement joint, and that can begin to loosen the joint and cause other problems.

Get a prescription for the antibiotics from your orthopedic surgeon or dentist. You'll be instructed to take four or five pills all at once an hour before your teeth cleaning or other dental procedure. Those antibiotics decrease the likelihood of bacteria surviving in your bloodstream, but they can give your guts a run for their money—and the runs. Your best bet to prevent an upset stomach is to take a daily dose of probiotics a couple of days before, the day of, and for at least a week after you go to the dentist. Lactobacillus and Bifidobacterium are strains found in yogurt that are added to soy products and in supplements. We recommend Digestive Advantage or Sustenex (they have armor-like shells that hold up through stomach acid) and Culturelle, a probiotic that actually gets turned on by stomach acid. Now smile—and get your teeth cleaned.

Antibiotics are important to prevent infection of an orthopaedic implant after dental procedures, because dental procedures can cause bacteremia, a condition in which bacteria can be introduced into the bloodstream. The bacteria can then settle on the prosthesis, which is usually metal and does not have a blood supply. This can then result in an infected joint and require removal and a lengthy process to remediate.