Thanks SP,

Yes, I can handle it in the first week or two of January. Things are typically
slow, once the post New Years Eve repairs peter out. I could schedule
preliminaries in the morning, block off time for the models and custom trays
then take finals in the mid afternoon. The lab on site gives me that
flexibility.

The problem then becomes would the DDS be finished his portion of TX. by then
AND how would that affect the AB regimen?

Thanks Shirley,

The name you are looking for is the American Academy of Orthopaedic Surgeons
(AAOS). The guidelines are published on their website at:

http://www.aaos.org/wordhtml/papers/advistmt/1014.htm

My concerns are the patient has rheumatoid arthritis that is listed in Table 1
item B. Having seen the patent today and now knowing that time frames for joint
replacement are a factor, I confirmed the last knee was replaced in 2001 (3
years ago).

Though my treatment falls into the lower incidence category of table 2, I think
the first line "Clinical judgment may indicate antibiotic use in selected
circumstances that may create significant bleeding." might apply since the
angular chelitis bleeds readily on merely opening the mouth.

The thought of using one of the newer non stinging liquid bandages just occurred
to me. Does anyone think that would help protect the patient during treatment? I
know the Methotrexate interferes with the cell metabolism needed to heal.

I've copied the relevant text from that site below:

There is limited evidence that some immunocompromised patients with total joint
replacements (Table 1) may be at higher risk for hematogenous infections.
Antibiotic prophylaxis for such patients undergoing dental procedures with a
higher bacteremic risk (as defined in Table 2), should be considered using an
empirical regimen (Table 3). In addition, antibiotic prophylaxis may be
considered when the higher risk dental procedures (as defined in Table 2) are
performed on dental patients within two years post implant surgery, on those who
have had previous prosthetic joint infections, and on those with some other
conditions (Table 1).

Table 1. Patients at Potential Increased Risk of Hematogenous Total Joint
Infection

 1.. All patients during the first two (2) years after prosthetic joint
replacement.
 2.. Immunocompromised/immunosuppressed patients
   a.. Inflammatory arthropathies (e.g.: rheumatoid arthritis, systemic lupus
erythematosus)
   b.. Drug -induced immunosuppression
   c.. Radiation-induced immunosuppression
 3.. Patients with co-morbidities (e.g.)
   a.. Previous prosthetic joint infections
   b.. Malnourishment
   c.. Hemophilia
   d.. HIV infection
   e.. Insulin-dependent (Type 1) diabetes
   f.. Malignancy
Table 2. Incidence Stratification of Bacteremic Dental Procedures*

HIGHER INCIDENCE1

 a.. Dental extractions
 b.. Periodontal procedures including surgery, subgingival placement of
antibiotic fibers/strips, scaling and root planing, probing, recall maintenance
 c.. Dental implant placement and replantation of avulsed teeth
 d.. Endodontic (root canal) instrumentation or surgery only beyond the apex
 e.. Initial placement of orthodontic bands but not brackets
 f.. Intraligamentary and intraosseous local anesthetic injections
 g.. Prophylactic cleaning of teeth or implants where bleeding is anticipated
LOWER INCIDENCE

 1.. Clinical judgment may indicate antibiotic use in selected circumstances
that may create significant bleeding.
   a.. Restorative dentistry2 (operative and prosthodontic) with/without
retraction cord
   b.. Local anesthetic injections (nonintraligamentary and nonintraosseous)
   c.. Intracanal endodontic treatment; post-placement and buildup
   d.. Placement of rubber dam
   e.. Postoperative suture removal
   f.. Placement of removable prosthodontic/orthodontic appliances
   g.. Taking of oral impressions
   h.. Fluoride treatments
   i.. Taking of oral radiographs
   j.. Orthodontic appliance adjustment

 2.. This includes restoration of carious (decayed) or missing teeth.
Here are some links for you, with the last being a PDF document summary produced
by the College of Dental Hygienists of Ontario:.
http://www.qualitydentistry.com/dental/information/abiotic.html

http://www.cda-ada.ca/jcda/vol-65/issue-2/95.html

http://www.aaos.org/wordhtml/papers/advistmt/1014.html

www.cdho.org/Recommend.PDF