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PBSC POLICY: Dental Prophylaxis

Princeton Brain & Spine Care is committed to providing our patients with the most up to date information regarding their care after spinal surgery.  Many patients have asked our doctors about dental procedures after spinal surgery.  The following guidelines have been adopted based upon our experience and training in spine surgery as well as the North American Spine Society and Congress of Neurological Surgeons/American Association of Neurological Surgeons literature about Dental Prophylaxis and Spinal Interactions.

The following are guidelines for the use of pre-procedure antibiotics for dental work in patients that have had have spine surgery.

SPINAL SURGERY WITH IMPLANTS:  For patients with a history of spinal surgery with implants (fusion, disk replacement, stabilization with metallic or plastic hardware): you will need to be pretreated with an antibiotic if dental work is needed within 24 months of your surgery. We recommend avoiding routine dental procedures for the first 3 months following a spinal fusion.  For 24 months after surgery, we suggest antibiotic therapy.  After 24 months, you will not need antibiotics. If you are significantly immuno-compromised, have Type I Diabetes Mellitus, history of previous infected spinal fusions, joint replacements, hemophilia, or malnourishment, then we suggest antibiotic prophylaxis for all future dental procedures regardless of timing. The choice of an antibiotic is a decision for you and your primary care physician (PCP).  Your doctor can call us to discuss any questions with our doctors.  We would be happy to discuss this with your primary care physician if there are any questions. 

SPINAL SURGERY WITHOUT IMPLANTS (non-fusion or non-disk replacements):  For patients with a history of spinal surgery without implants (microdiskectomy, foraminotomy, and laminectomy): We recommend avoiding routine dental procedures for 3 months following surgery.  If you must have a dental procedure within 3 months, then it would be advisable to use antibiotics.  We do not make recommendations about the choice of antibiotics, but would be happy to discuss this with your primary care physician.  Most of the time physicians can make this decision without our guidance. We would be happy to discuss this with your primary care physician if there are any questions. 

CRANIAL SURGERY INCLUDING VP SHUNT:  For patients with a history of cranial surgery including VP shunt and/or surgery for aneurysms, AVMs, brain tumors, and Chiari malformations: We recommend avoiding simple dental procedures for 3 months following the surgery.  If you must have a dental procedure within 3 months, then it would be advisable to use antibiotic prophylaxis.  We generally do not make recommendations about the choice of antibiotics.  We would be happy to discuss this with your primary physician if there are any questions. 

VENTRICULAR ATRIAL SHUNT (VAS):  For patients with a history of ventricular-atrial shunts (shunts with tubing going from the brain into the heart):  You will need to be pretreated with an antibiotic if you have dental work within 24 months after surgery.  We recommend avoiding routine dental procedures for 3 months following a VAS shunt placement, but between 4 and 24 months, we suggest antibiotic treatment.  After 24 months, you will need to discuss the option of antibiotic treatment with your primary care physician.

 

LastUpdate: 2016-04-04 13:41:56

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