prophylaxis for dental work

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Hi

This was posted to another list a while ago. Hope it helps.

Sanette

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ANTIBIOTIC PROPHYLACTIC TREATMENT FOR DENTAL WORK IN PATIENTS WITH

SPINAL IMPLANTS

JOHN I. WILLIAMS, M.D. and RICHARD T. HOLT, M.D.

Spine Surgery, PSC, 210 East Gray Street Suite 601,

Louisville, Kentucky 40202 (502) 585-2300

For patients with spinal implants, do you recommend antibiotic prophylactic

treatment for dental work if there is a possibility of bleeding? This is a

commonly asked question posed by patients who have orthopaedic implants and

it

is a controversial issue that has been the subject of considerable debate

since total joint arthroplasty became commonplace in the 1970's. It is a

reasonable concern that dental procedures, particularly those involving

gingival bleeding,

would produce a transient bacteremia (the presence of bacteria for a short

period of time in the blood stream) due to commonplace oral bacterial flora.

As a result of this concern, orthopaedic physicians began routinely

prescribing

antibiotics prior to dental procedures in total joint arthroplasty1.

Multiple scientific studies have been published on both sides of this issue.

In reviewing the recent maxillofacial surgery literature, primary care

physician literature and orthopaedic surgery literature, it seems that the

pendulum

has currently swung to not recommending prophylactic antibiotics on a

routine

basis around the time of dental procedures.2,3,4

Field and 4 note that while certain medically compromised patients

with

artificial joints have a slightly increased risk of infection thereby

justifying the use of antibiotic prophylaxis, routine use of prophylaxis for

the majority of the patients with artificial joints is not justified.4

Weitekamp and Caputo reviewed the subject of prophylactic oral antibiotics

in

general and concluded that, while the patients at risk for

bacteroendocarditis

remained candidates for prophylactic antibiotic therapy, " antibiotics

are not

necessary in most patients with prosthetic joints who are undergoing dental

procedures " 3.

Dr. Norden reported on prophylactic antibiotics in orthopaedic surgery

specifically and noted that there was " insufficient evidence to support

antibiotic prophylaxis " for routine dental work in most patients with

total

joints He felt that in individuals with " periodontal disease and

potential

dental infection, antimicrobial prophylaxis seems indicated. " 2

To our knowledge, there is no specific study looking at the use of

prophylactic oral antibiotics around the time of dental procedures in

scoliosis patients with spinal instrumentation implants. Based on our review

of the general orthopaedic literature, however, there are some conclusions

we

can make for scoliosis patients until a specific study is produced in this

regard. Prophylactic antibiotics are not necessary in most scoliosis

patients

with spinal implants undergoing dental procedures. The potential exceptions

to

this include medically compromised patients - particularly patients at risk

for

bacterioal endocarditis, individuals with severe periodontal disease, or

individuals with potential dental infections.

BIBLIOGRAPHY

1. Carlsson AS, Lidgren L, Lindberg L. Prophylactic Antibiotics against

Early

and Late Deep Infections after Total Hip Replacements. Acta Orthopaedica

Scandinavica 1977; 48:405-10.

2. Norden CW. Antibiotic Prophylaxis in Orthopaedic Surgery, Reviews of

Infectious Diseases 1991:13 (Supplement 10): S842-6.

3. Weitekamp MR and Caputo GM. Antibiotic Prophylaxis: Update on Common

Clinical Uses, Clincal Pharmacology, American Family Physician, September

1993, Vol. 48, No. 4.

4. Field EA and MV. Prophylactic Antibiotics for Patients with

Artificial Joints Undergoing Oral and Dental Surgery - Necessary or Not?

British Journal of Oral and Maxillofacial Surgery. 1991, October: 29 (5)

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