Questions I asked yesterday: Dental antibiotic prophylaxis

[txmarinemom]

A few topics have been bouncing around here lately, and I added them to my list of questions for Hanson yesterday. The topics will all start with the subject "Questions I asked yesterday:" ...

Let's try to get a collection of answers!

If you answer, please refrain from quoting PubMed articles anyone can pull - that aren't even necessarily peer-reviewed.

Also be sure to name your surgeon, his speciality, and whether he's an SRS member.

Mine, as many of you know is:

Darrell S. Hanson, MD
Baylor College of Medicine, Houston, TX (and, yes, he's SRS)

Specialties:

Adult Scoliosis
Aging Spine
Degenerative Conditions
Juvenile/Infantile Scoliosis

__________________________________________________ ___

On the topic of whether dental pre-med is required after fusion surgery, he never recommends it.

Regards,
Pam

[Geish]

Dr Ganocy told me yesterday that while it isn't necessary it can't hurt "just in case". My decision is no pre-medicating before dental work. Doesn't seem like it is needed so why take it?

T Kent Ganocy II, MD
Southern California Permanente Medical Group
4760 Sunset Blvd, Los Angeles, CA
Adolescent, Adult Scoliosis, Aging Spine, Degenerative Conditions
SRS
Trained under Dr Boachie, as well as others.
(He was actually a few years ahead of Hanson in Texas, I asked him if he knew him yesterday and he kind of chuckled and said Hanson was a Jr resident when he was there. Had great things to say about him.)

[mariaf]

Back in 2004, a few months after his VBS surgery, David was due for his annual dental cleaning/checkup. At that time (procedure may have changed in the past four years), we were told by Dr. D'Andrea at Shriners, Philadelphia, that they prescribed meds prior to dental work for the first year post-op.

I have heard varying opinions on this though - seems to differ from surgeon to surgeon. For instance, I heard from someone that their doc said they are only needed for "dirty dental work", etc. Others feel it isn't necessary at all.

It should be interesting to hear the different responses.

[trulyaries]

Well, here you go ... neither one of the two orthopedic surgeons I have had ever mentioned anything about pre-medicating. However, I have mitral valve prolapse and for that reason both my primary care doctor and my dentist have me pre-medicate whenever I have ANY dental work done.

[loves to skate]

loves to skate

I went to the dentist today for a cleaning. I'm 4 months post-op. The subject was brought up and I said I thought it was no longer required. The dental hygienest (is there a spell checker on this site) agreed that it is no longer required, she was just checking. Dr. Rand never said anything to me nor did I ask him. The Cardiologist who checked me out before surgery told me it is no longer suggested or required for prolapse mitral valve.
Sally

[Singer]

Dr. Boachie wants all his spine patients to take 2,000 mgs of amoxicillin before each and every dental procedure for 5 years post-op. I would rather be safe than sorry. I'm not too worried about antibiotic resistance because I have very good teeth (just cleanings every 8 months or so) and I can't remember the last time I took a course of antibiotics.

I also have a mild case of mitral valve prolapse which I've never premedicated for.

It's interesting to me that there is such a wide variance of opinions on this in the medical community. It makes me realize that medicine is indeed an art and not a science.....

[CHRIS WBS]

I agree with you Chris about the varying opinions. It’s got me now wondering why I will be required to do this for the rest of my life.

[PNUTTRO]

Porphylactic antibiotics

The only time I even heard of antibiotics before a dental procedure is when there is a risk if infection to the heart--endocarditis. Usually, for someone who has had an open heart surgery.

If you have an abscess in your mouth, the dentist always will prescribe antibiotics before a procedure. For general cleanings or dentistry, there may be blood in the mouth, but generally in a healthy individual (and one with recent surgery or implants) there is little risk of infection to another site, in my opinion.

I also believe that antibiotics are overused.

[JanL]

Dr Bridwell's post op instructions include antibiotics prior to dental work for 2 years.

[Pips]

I saw my surgeon recently and asked him about dental work.

He told me that I would need dental pre-med antibiotics if I was ever to have anything done (including cleaning) - I asked for how long and he said for life.

Again, like many people I would rather be safe than sorry.

My surgeon is Paul Davies, based in the UK.

[scoliboymom]

Patrick's surgeon says not necessary for routine work/cleaning but for bigger stuff like a root canal he should have antibiotics. Hopefully he'll never need a root canal.
Ramona

[Geish]

I ran into my dentist in the grocery store the other day and she said I should use antibiotics for the first year following this surgery.

[trulyaries]

Another example ...

... of physician instructions that are all over the map. I have been pre-medicating for years, I thought for mitral valve prolapse. Neither of my spine surgeons said anything about pre-medication. When I saw my dentist the other day, he said I am pre-medicating because of the back surgery, not because of mitral valve prolapse. The dentist wants me to pre-medicate for two years following surgery. I called my surgeon's office and his PA told me I should pre-medicate for 6 months. I asked why I wasn't told that, and she said they count on the dentist to follow up, which I thought was a pretty lame answer. My dentist was a little irritated because he says lots of doctors don't tell their patients about pre-med and they do leave it to the dentists to catch it. The dentist of course says "it can't hurt" but I'm also determined not to spend my "senior years" with a bucketful of medications that may or may not be necessary.

[Pips]

They're all different, aren't they. You'd think there would be a standard wouldn't you?

I think maybe mine is for life because I had to have a steel rod rather than titanium because of the stiffness of my spine - something to do with leverage he said, when working to get my correction. I think he said that titanium is more brittle and they thought it would break so decided to use stainless steel.

[samsmom]

Sam's doctor said that "YES" she would need to take antibiotics as a precaution before any dental work done in the next 2 years and that includes cleanings. I asked a friend of mine who is a dental assistant and she said that her office recommends the pre-medication for hip and knee replacement as well as spinal fusion.... something about the bacteria being drawn to the metal.
- Michele