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 Martin4 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 Martin 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) 341-6.

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