Dental work

[dianeh]

Hi,

I was just wondering what people have been told
about dental work and pre-medication after surgery?
I am 2 years post-op and have only had cleanings
since my surgery. I'm seeing a new dentist who is
concerned about this. My surgeon says it's not necessary.
Is that pretty much the consensus?

Thanks, dianeh.

[CHRIS WBS]

Hi Dianeh,

I was told that I will require antibiotics prior to any dental work for the rest of my life once I have metal implants in my spine since there is always the risk of bacteria entering your system during dental procedures.

Chris

[Susie*Bee]

Mine said for 2 years...* I've been taking 4 Amoxicillin 500.mg one hour before dental work -- including cleanings. It sure wouldn't hurt to take it for life. I guess there's a ton of bacteria released when they clean your teeth, etc. Gross!!!

*He also said that was playing it safe-- that was in line with what hip/knee replacement surgeons usually recommend... and it probably wasn't necessary with spinal fusion w/instrumentation people. I think that supports what Pam found.

[vndy]

My surgeon said it wasn't really necessary, but my dentist said he'd rather be "safe than sorry" and pre-medicate me with antibiotics, so that's what I did. I figure I don't take a ton of antibiotics otherwise, so I'm not really at risk for them to becoming ineffective.

[Singer]

I was told to take four 500-mg. amoxicillins before each and every dental procedure for a total of five years post-op.

[txmarinemom]

I was just wondering what people have been told about dental work and pre-medication after surgery? I am 2 years post-op and have only had cleanings since my surgery. I'm seeing a new dentist who is concerned about this. My surgeon says it's not necessary. Is that pretty much the consensus?

My collection of "bonus" body parts over the years include/have included:

• I have titanium/Vitallium fusion hardware (7.5 weeks old); and
• I have stainless screws in my right ankle; and
• I had stainless screws in my right knee (now removed), and
• I even have a ventriculo-peritoneal (VP) shunt for communicating hydrocephalus

No ortho, scoli surgeon or neurosurgeon has ever recommended I need prophylactic antibiotics (i.e., pre-medication) prior to dental work. The one or two dentists who ever suggested I did were just doing CYA (and dropped the issue after a simple verification with the relevant M.D.).

I just did a quick run through of PubMed and pulled all I could find on antibiotic prophylaxis: There's still some question whether it's still standard for endocarditis, joint replacement recipients (and even one article on those with penile implants!), but nothing specific to spinal fusion (or any of its alternate monikers).

Out of the data my queries returned, it seems joint replacement would be most similar, and even those with total joint replacements aren't routinely pre-treated these days. Here are a few links that might be of use:

from Dentistry.com

American Dental Association

I've got a lunch date with an orthodontist buddy at noon: I'll call him in just a bit and see if he can find anything I missed specifically related to spinal fusion and report back here later today.

If they barely require it after joint replacements (and then, only in high risk patients) and not after (even immediately after) major neurosurgery, it would seem there's not much of a risk after spinal fusion.

Personally, I routinely refuse antibiotics without a valid reason. Overuse (and unfinished treatment rounds) have only served to create stronger, antibiotic resistant bacteria (i.e., MRSA, VRE),

My 7 weeks follow-up (actually at 8 weeks) is scheduled with Hanson next Tuesday. I'll be sure to add this question to my list.

BTW, the date next Tuesday is ... April 1st (evil laugh). This should be a fun visit as I excitedly describe how much fun I had water skiing all weekend - and what a great job he must have done because I wasn't even sore afterwards!

He half suspects I'm a maniac *anyway*, so my guess is I can get a few seconds of shock out of him .

(You gotta seize your amusement when and where you can!)

Regards,
Pam

[Karen Ocker]

There's still some question whether it's still standard for endocarditis, joint replacement recipients (and even one article on those with penile implants!), but nothing specific to spinal fusion (or any of its alternate monikers).

My gastroenterologist said the newest recommendations from the cardiologists say it's no longer recommended for persons having cardiac issues who also have assorted joint implants.

[txmarinemom]

My gastroenterologist said the newest recommendations from the cardiologists say it's no longer recommended for persons having cardiac issues who also have assorted joint implants.

Yeah, I actually saw some other article/studies after I posted to that effect (there are really very few cases where it's warranted anymore ... it appears the patient must be *extremely* high risk).

Protocol has certainly changed!

I worked for a dentist all through high school (early to mid-'80's), and they routinely pre-treated TONS of patients (even before cleanings) who'd had rheumatic fever to lower the risk of endocarditis.

Regards,
Pam

[Snoopy]

I was told my daughter needed to be pre-medicated as a precaution for one year post-op and only for things that would/could cause bleeding.

My mom, however is pre-medicated before every dental appointment and I think she is even pre-medicated for things like having heart stents placed. She does so because she has artificial knee joints.

Pam,
Enjoy the look on your doctor's face on Tuesday. My youngest daughter was born on April 1st (no kidding, I'm serious) which by the way was her due date. At the time, I had a 19 1/2 month old daughter at home and my dad called everyone he knew and told them I had twins! I couldn't imagine having three children under that age of two!

Mary Lou

[skoshi314]

Pam, you're so bad! My kind of woman!

[loves to skate]

loves to skate

I love Pam's sense of humor also.
I had a cardiology consult as part of my pre-op as I was diagnosed with prolapsed mitral valve more than 20 years ago and was supposed to take antibiotics prior to dental work and refused after getting a yeast infection every time. As it turns out the Cardiologist said I was right not to take the antibiotics. It is no longer recommended. And, he did a repeat echo cardiogram and I don't have prolapsed mitral valve after all. Pam is correct about overuse of antibiotics causing super bugs. By the way, general usage of antimicrobial hand soaps also contributes to creating super bugs. Just my two cents worth.
Sally

[dianeh]

Dental work

Thanks everyone for replying to my question. I'm going to pre-medicate for
my procedure next week while I think this over a bit.
dianeh