surgery, dentist

Question

I recently had screws put in my ankle and went for my dental cleaning and the dentist said because of the surgery I had, I would have to take antibiotics 1hr before my appointment, and I wasn’t able to see him that day. When I talked to my surgeon about this, he said I did not need antibiotics. Why would I need them in the first place? What are the risks of getting my teeth cleaned 2 months post-op?

Answer

When you have your teeth cleaned or other invasive dental procedures, the bacteria in your mouth can enter your blood stream in small amounts. For most people, this rarely causes a problem and your immune system rapidly clears the bacteria. However in patients who have severely compromised immune systems, abnormal heart valves or artifical heart valves, antibiotics are recommended immediately before the procedures to prevent the heart valves from becoming infected or to prevent a severe infection. This called dental prophylaxis.

To my knowledge, there is no formal recommendation to do dental prophylaxis for the orthopedic screws. I think the risk of the screws becoming infected after teeth cleaning is very low. However, your dentist cannot be faulted for being careful. Another situation where this topic comes up is the use of antibiotics for dental prophylaxis in patients who have total joint replacements. Some physicians use antibiotics in the first year after the replacement when the risk of infection is the highest.

Alan Matsumoto, M.D.

About Alan Matsumoto, M.D.

Part-time Faculty, Division of Rheumatology
Johns Hopkins University