Antibiotics before dental appts after surgery??

[JenM]

Hi all-

I was reading on Melissa's revision thread about having to take antibiotics before going to the dentist after having spinal fusion surgery. I am just curious if most of the surgeons tell their patients to do this. My surgeon never mentioned anything to me about this and I am curious because I have a dentist appointment in 3 weeks. Since my surgery in 2010, I have been to the dentist 3 times and have never taken any antibiotics! My dentist even knows I have had the spinal fusion surgery to correct my scoliosis. I have even had a crown put in since my surgery. I am kind of worried now.

I am also wondering what other situations require you to take antibiotics beforehand as a result of having the spinal fusion surgery. This past summer, I had another type of "mini" surgery done by my OBGYN and took nothing!! Am very concerned about this...Would appreciate some input! I'm now thinking anytime you have any surgery you should take antibiotics beforehand. I am definately calling my surgeons office this week to inquire about this!

Thanks,
JenM

[LindaRacine]

Hi...

I've never confirmed this, but I get the sense that when patients ask their surgeons if they should take antibiotics, they are told that they should. On the other hand, if the patient never asks, it's never recommended. I'd be interested in hearing if anyone had the antibiotic issue mentioned in their preop materials.

By the way, not sure why you started another thread. When there's two threads active on the same subject, it seems very confusing to me.

--Linda

[Snoopy]

Hi...

I've never confirmed this, but I get the sense that when patients ask their surgeons if they should take antibiotics, they are told that they should. On the other hand, if the patient never asks, it's never recommended. I'd be interested in hearing if anyone had the antibiotic issue mentioned in their preop materials.

--Linda

This might be true for my daughter. Because my mom had total knee replacements and had to pre-medicate before any dental appointment, I asked Jamie's surgeon. He told us to pre-medicate for a year, just as a precaution. I don't remember anything being said in pre-op appt. about pre-medicating.

Mary Lou

[Pooka1]

Our surgeon seems to agree with Mary Lou's.

He said antibiotics for oral surgery (and therefore more mundane dentistry) are only required in the case of joint replacements, not spinal fusion.

When my daughters needed oral surgery, the oral surgeon asked us to ask our orthopedic surgeon who said they were unnecessary. The oral surgeon decided to prescribe them anyway.

The situation with spinal fusion and prophylactic antibiotic use is either known or it is not. If it is known then I would like to see the evidence.

[Jacque's Mom]

Linda - Was never mentioned in the pre-op info. When I went to my dentist for a cleaning about three months after my surgery, the dental office called Dr. Boachie's office and was told about the antibiotics for five years. If the dental office didn't call, I wouldn't have known. I never took them before with the other surgeries. Lynn

[nanut]

I had a dental appointment 2 weeks ago. My surgeon said no need for antibiotics. I spoke to my dentist about it and he said pre procedure
antibiotics are recommended for "replacement surgeries". Neither one of us could figure out why spinal surgeries with hardware were any different than hip or knee replacement surgeries. He was going to do some research.
Nan
53 y/o
Surgery July 12, 2011
University of Utah-Dr. Michael Daubs
T10-L-5
Preop Lumbar curve 55 degrees

[Mojo's Mom]

My pre-op general information paperwork does say that I will need prophylactic antibiotics before dental work after my surgery.

[loves to skate]

I got the following information from the American Dental Association website. I included the entire article so that you can see why it isn't such a good idea to take antibiotics if you don't need them. Make sure to read all the way to the bottom of the article. I think that the reason some Doctors say to take them if they are asked is to cover themselves on the rare chance that some adverse problem should arise and they probably haven't read the latest research on the subject. I used to take antibiotics proplylactically for dental work because of Mitral valve prolapse and every time ended up with a yeast infection, so I decided for myself not to take them anymore. As a Medical Technologist, I also didn't like the idea of developing a "super bug".
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Before some dental treatments, patients who have certain heart conditions and those with artificial joints take antibiotics. These people may be at risk of developing an infection in the heart or at the site of the artificial joint, respectively. Antibiotics reduce this risk. This is called antibiotic prophylaxis (pronounced pro-fuh-lax-iss).

When treating patients with heart conditions, dentists follow recommendations developed by the American Heart Association (AHA), with input from the ADA. For patients who have total joint replacements, they refer to recommendations developed by the American Academy of Orthopedic Surgeons (AAOS).
Recommendations for People with Heart Conditions

The AHA recommendations are meant to reduce the risk of infective endocarditis (pronounced end-o-car-die-tiss). Infective endocarditis (IE) is an infection of the lining inside the heart or the heart valves.

In the past, a number of heart conditions were thought to put patients at risk for IE. When writing the new recommendations, the AHA looked at published research and other scientific articles. They found that fewer conditions were associated with IE. As a result, a smaller group of patients needs to premedicate before dental treatments.
Why did the recommendations change?

After looking at the published scientific reports and articles, the AHA concluded that:

the risks of adverse reactions to antibiotics outweigh the benefits of prophylaxis for most patients. Adverse reactions can range from mild (rashes) to severe (breathing problems that could result in death).
when all the study results were looked at together, it wasn’t clear that premedication prevented IE.
bacteria from the mouth can enter the bloodstream during daily activities like brushing or cleaning between the teeth. Once in the bloodstream, it can travel to the heart. People at risk of infection might be more likely to develop IE from these activities than after a dental treatment.

Also, bacteria that cause infections can become resistant to antibiotics if those drugs are used too often. Because of this, doctors try to limit the use of antibiotics.
Patient selection

The current recommendations recommend use of preventive antibiotics before certain dental procedures for people with:

artificial heart valves
a history of infective endocarditis
a cardiac transplant that develops a heart valve problem
the following congenital (present from birth) heart conditions:*
unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device.

* Check with your cardiologist if you’re not sure whether or not you fall into one of these categories.

People who took prophylactic antibiotics in the past but no longer need them include those with:

mitral valve prolapse
rheumatic heart disease
bicuspid valve disease
calcified aortic stenosis
congenital (present from birth) heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

Talk to your dentist about how these recommendations might apply to you.
Additional resources

American Heart Association downloadable wallet card (available in English and Spanish)
For the Dental Patient: Antibiotics and Your Heart

Return to Top
Recommendations for People with Total Joint Replacements

Recommendations from the AAOS are meant to reduce the risk of infections at the site of an artificial joint. They apply to people who have total joint replacements. Patients who have pins, plates or other orthopedic hardware are not affected.

AAOS recommends that dentists and physicians should consider whether patients who have total joint replacements should take antibiotics before certain types of dental procedures.Talk to your dentist about how these recommendations might apply to you.

[Elisa]

Nothing was mentioned to me about antibiotics before dental visits. Elias had a checkup/cleaning two weeks ago and the hygienist asked him if he had any new medical conditions and he told her that he had surgery for scoliosis six months ago and that didn't seem to bother her. I would like to find out for sure though b/c he has another appointment in six months. *confused*

[golfnut]

I did not ask about taking antibiotics before getting my teeth cleaned, but the "Spinal Fusion" booklet that I was given recommended doing so following surgery.

[loves to skate]

I did not ask about taking antibiotics before getting my teeth cleaned, but the "Spinal Fusion" booklet that I was given recommended doing so following surgery.

How old was the "Spinal Fusion" booklet? It may have been printed before the newer research came out four or five years ago.
Sally

[JenniferG]

My surgeon didn't mention taking antibiotics before dental work and I didn't know to ask. I've been to the dentist since surgery and my dentist knows about my implants and wasn't concerned.

[JDM555]

I've been to dentist handful of times in past 1-2 months and wasn't told anything about infections/antibiotics at all.

[mabeckoff]

I did not know that this topic had some differing opinions

[golfnut]

Sally,
I think the spinal fusion book is fairly old, but after reading it, Dr. Lenke's office verified that I should take the antibiotic 1 hour before my teeth cleaning. Possibly, they don't know the latest research.