Dentist visits with antibiotics for LIFE post-op?

[Rutabaga]

I attended a preoperative joint replacement informational class today and have a question about something I heard. The nurse giving the presentation mentioned that after you have surgery, you must take antibiotics before having any dental work done. Then she said that this includes routine cleanings! THEN she said this has to be done for the rest of your life.

So does this mean I have to take antibiotics twice a year for dental cleanings for the next 70 years? That sounds crazy! It can't be good for me to take antibiotics that regularly for so long. Can someone shed some light on this subject for me?

 

[beachgal]

Different schools of thought on this. My dentist has me pre-medicate with 4 500 mg amoxicillin before my visits whether for cleaning or other stuff. About a year after my THR, I had an abscess that required some attention and I pre-medicated prior. Now. I'm a bit over 18 months from THR and have been seeing an endodontist for a couple of root canals and he also has me pre-medicating but said he believes I should only do this for 2 years after THR.

There have been many studies on whether dental infections can locate near your prothesis but it takes so long for the symptoms to become apparent, there is little way to track if it was dental work or some other source. The chances of this happening are quite slim but worth taking a few pills for a while to be cautious.

I haven't decided if I will quit at 24 months or not but my sister, who has myocardial infarction has to pre-medicate before every dental visit (also colonoscopies and other out-patient procedures and will have to adhere to that routine for life.


Sent from my iPhone using BoneSmart Forum

 

[djklaugh]

@Rutabaga Like @beachgal I did antibiotics for dental procedures after my hip replacements - on orders from my surgeon and from dentist (in fact this is the protocol of my HMO insurance). BUT I only had to do that for 2 years - not a real big deal. I'd say do not go by what this particular nurse said (after all she does not know you, your situation, or what any individual surgeon might recommend)- ASK your surgeon! He/She is the one to say what is necessary and what is not.

 

[Jamie]

The older thought process was that this pre-medication was necessary for at least 2 years following surgery. But the most current studies have not proven this to be necessary. So, depending on when your surgeon was trained, whether or not he has reviewed some of the most current material, you may get a recommendation for 2 years or not at all for use of pre-meds. You need to do what feels comfortable for you after talking with your doctor. Just know that meds are not needed for life. The nurse was wrong about that. Here is an article from our BoneSmart Library that provides some additional information.

 

[Jaycey]

I asked my surgeon, my dentist and my GP about this. All said the current school of thought is antibiotics are not necessary - especially for routine procedures like cleaning. I have had both hips replaced and have a dental check and cleaning every 6 months.

 

[Nana757]

As most everyone has said here, different strokes for different folks. When I was coming up on my surgery, I read just about everything there was to read about dental work and antibiotics. There is a lot of different opinions, but what I got out of all my reading was that there was no definitive correlation between dental work and hip infections. With that said, though, my OS prefers his patients pre medicate with 4 amoxicillin tablets an hour before dental work. Since I am one who errs on the side of caution, I have no problem with this protocol. Better safe than sorry, I always say. I also had to have dental work done, prior to my surgery and was loaded up with antibiotics with each procedure.

 

[SuperSnapper]

In the UK we don't get antibiotics before dental work and recent research says it's not necessary. Antibiotics have been far too widely used for all kinds of things and have resulted in strains of resistant bacteria. I think better safe than sorry is not right in this case. http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/ The World Health Organisation advocates that antibiotics should only be prescribed when they are really neeeded.

 

[Nana757]

@SuperSnapper
I appreciate your informative post, but my comment of "better safe than sorry" is my philosophy and only applies for me, in particular, and wasn't intended to be construed as public opinion. And, while the WHO may view pre dental antibiotics as unnecessary, I don't always trust dental offices and their equipment to be a completely sterile environment. I am one who chooses to be cautious, at least for the next couple of years. And twice a year with a 1-time dose of antibiotics seems to be a small price to pay to ward off any possible infection that may or may not compromise the health of my hip. But, like I said, different strokes for different folks. It would seem that there are quite a few OS's here in the US who still feel preventive measures are warranted.

 

[Hip Hip Hooray!]

I just went in for a cleaning and had to have a crown and filling replaced. I read the Bonesmart articles and called my surgeon. He has us take antibiotics for two years after surgery. (He has read the articles and also gave them to us.) He still feels it's important. My dentist gave me a prescription and had me take four pills one hour before the appt. He did everything together, so I would only have to take the antibiotics once. He said I didn't need to take them when I returned for the permanent crown. I haven't taken antibiotics that much in my life, I've been very healthy.

At my appointment I was kind of paranoid. I noticed the nurse left and went and talked on her cell phone, then came back to work on me. There were kids playing in the room where he did my crown before my appt. They were fiddling with the sink, foot pedal, etc. All I could think about was sterility...

You have to decide what's best for you. I felt better taking the antibiotic. I want to keep this hips for the rest of my life, if possible. (I've also had two dental infections.) One was my after having my wisdom teeth out, the other time was a crown that wasn't on properly. It just felt too risky to me to not take the precautions.

 

[Granny Di]

Hello All! Today I made an appointment for an implant and the dentist prescribed antibiotics. My pharmacist had told me that they were no longer required for dental work and I understand and agree that overuse has contributed to resistance in bacteria. I would be willing to go without but they will not treat me so I take the pills. Just thought I would add my two cents.
Diane

 

[Rutabaga]

Thanks for all your informative replies. The preoperative meeting I went to was presented by the city hospital. I will be having my surgery at an outpatient clinic, not at the hospital, so I am not sure my surgeon will have the same opinion as them on everything. I will talk to him about it. I tend to agree with @SuperSnapper; I would rather avoid antibiotics if all all possible. The thought of taking them so often is worrisome to me. When I heard the nurse say this I just started thinking "what am I getting myself into?" and wondering if there are other surprises in store for me as a younger patient. Maybe there are other consequences of THR that I haven't thought of at this point.
Taking prophylactic antibiotics for dental visits for two years seems more reasonable to me.

 

[Rutabaga]

@Hip Hip Hooray!
I thought that the risk of bacterial infection from dental work was as a result of bacteria being dislodged from your own mouth and making its way into your bloodstream. I remember learning about this in a college microbiology class long ago. Maybe it just stuck with me. But you are implying that the risk of infection comes from poor sanitation/sterility practices of the dental office?

Anyone know which is true?

 

[Hip Hip Hooray!]

I think the first infection from my wisdom tooth was because the dentist accidentally left a bandage inside of my mouth. The gum was growing over it. Plus, infections happen sometimes with wisdom teeth being extracted. I went back, he removed the bandage, cleaned the tooth with saline solution, and I healed.

The second time, the crown was on like a beret, because my teeth were so crowded. I should have had my upper wisdom teeth removed to prevent it, but I didn't want to...I've had a lot of dental trauma in my past. It did get into my blood stream and made my perspiration smell putrid. I didn't get sick, but it was obviously toxic. Once I had the decayed upper wisdom tooth removed, and the crown replaced, everything was fine. No more odor.

I don't feel safe if things aren't sanitary at the dental office. I'm not knowledgeable when it comes to how infections are contacted or spread. It sounds to me like even the surgeons aren't completely clear. I'm just very cautious with these new hips. I could be wrong. I follow my intuition. I also have great trust in my surgeon.

 

[Hip Hip Hooray!]

I'm thinking I might just go to the dentist once a year. (unless I have pain.) I use a preventive system by Dr. Ellie that has worked really helped my teeth. I didn't get any cavities for 14 years. She has you use zylitol and certain mouth rinses. It's worked for me for the past fifteen years.

I understand your concern about the antibiotics. It's good that you are doing your research. I also include a lot of raw garlic in my diet.

 

[SuperSnapper]

I know some people are really worried about this but the bottom line is if we continue to abuse the use of antibiotics and take them before we even have infections, pretty soon they won't work at all because antibiotic resistant strains will have taken oven. There are already some against which the antibiotics we have now do not work. I don't want my grandchildren to die from papercuts because our generation took antibiotics when it wasn't necessary. Food for thought.

 

[Josephine]

The nurse giving the presentation mentioned that after you have surgery, you must take antibiotics before having any dental work done. Then she said that this includes routine cleanings! THEN she said this has to be done for the rest of your life.

She is working on old thinking. Read this and note its sources Evidence insufficient to recommend prophylactic antibiotics for dental procedures

 

[Rutabaga]

I had my pre-op appointment today and they did tell me I would need to take antibiotics for life before visiting the dentist, even for cleanings. I voiced my concerns and the nurse just said, well it's only a one-day dose, it's not a 10-day cycle or anything, so not to worry, it's not a big deal.

Not sure what to do. I'm thinking I should just follow this advice for the first few years after surgery and then stop? I definitely don't feel comfortable taking antibiotics that frequently for the rest of my life.

 

[jomarie58]

Hopefully this question will be resolved in the next few years! I was also told that I would have to take antibiotics for the rest of my life!


RTHR 1/15/2016. Posterior approach. Due to AVN. LTHR in my future.

 

[liucheang]

@Josephine I know that many say dental procedures no longer require antibiotics. But what about existing dental caries? I can't afford to have them all fixed and I do not qualify for their payment plan. Can dental caries infect my bilateral hips done many, many years ago if I can't afford to have them fix? I'm seriously thinking of having them all taken out and get dentures.

 

[Josephine]

"Many" don't say it - it was a statement issued by the AAOS/ADA/BOA on the grounds that was that there is NO EVIDENCE of oral bugs being the cause of per-prosthetic infection. This doesn't matter when or how the infection occurs, that is the fact of the matter. And have dental caries doesn't inevitably mean there is infection though the pathogen load in your mouth might be a bit heavier and because of that your surgeon might prefer you get it sorted beforehand, just as a sensible precaution.