Dental Prophylaxis

Patient Instructions: Dental Prophylaxis

Guidelines for teeth cleanings, other dental work and pre-treating with antibiotic

Spinal surgery with implants

For spinal surgery with implants (fusion, disk replacement, stabilization), patients will need to be pretreated with an antibiotic if you have dental work done within 24 months of the surgery. We recommend avoiding routine dental prophylaxis and simple procedures for 3 months following a spinal fusion, but between 4 and 24 months we suggest antibiotic prophylaxis. After 24 months, you will not need antibiotic prophylaxis unless you have a compromised immune system, Type 1 diabetes mellitus, previous infection of a prosthetic joint or a spinal fusion, hemophilia, or malnourishment. The choice of antibiotic is a decision for you and your primary care doctor. Please contact their office for antibiotics or further advice. We are happy to discuss this with them should they need to contact us. If you have significant immune compromise, Type 1 diabetes mellitus, history of previous infected spinal fusions or joint replacements, hemophilia or malnourishment then we suggest antibiotic prophylaxis for ALL future dental procedures regardless of timing, but this again is something that needs to be resolved through your primary care physician and not your neurosurgeon. If there is any confusion please have them call us.

Spinal surgery without implants

For spinal surgery without implants (microdisckectomy, foraminotomy, laminectomy), we recommend avoiding routine dental prophylaxis and simple procedures for 3 months following a 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 choice of antibiotic when using it for prophylaxis, but we would be happy to discuss this with your primary doctor. Most of the time patients can make this decision without our guidance, but please have them contact us if there are any concerns.

Functional surgery or surgery for pain

For functional surgery or surgery for pain (deep brain stimulators or spinal cord stimulators), we recommend avoiding routine dental prophylaxis and simple procedures for 3 months following a 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 choice of antibiotic when using it for prophylaxis, but we would be happy to discuss this with your primary doctor. Most of the time patients can make this decision without our guidance, but please have them contact us if there are any concerns.

Peripheral nerve surgery

For peripheral nerve surgery (Carpal Tunnel), we recommend avoiding routine dental prophylaxis and simple procedures for 3 months following a 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 choice of antibiotic when using it for prophylaxis, but we would be happy to discuss this with your primary doctor. Most of the time patients can make this decision without our guidance, but please have them contact us if there are any concerns.

Cranial surgery including VPS

For cranial surgery including VPS (including surgery for aneurysms, AVMs, brain tumors, shunts, chiari malformations), we recommend avoiding routine dental prophylaxis and simple procedures for 3 months following a 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 choice of antibiotic when using it for prophylaxis, but we would be happy to discuss this with your primary doctor. Most of the time patients can make this decision without our guidance, but please have them contact us if there are any concerns.

Ventriculoatrial shunt

For ventriculoatrial shunt (shunts that go from the brain to the heart), patients will need to be pretreated with an antibiotic if you have dental work done within 24 months of the surgery. We recommend avoiding routine dental prophylaxis and simple procedures for 3 months following a VPS placement, but between 4 and 24 months we suggest antibiotic prophylaxis. After 24 months, you will not need antibiotic prophylaxis unless you have a compromised immune system, Type 1 diabetes mellitus, previous infection of a prosthetic joint or a spinal fusion, hemophilia, or malnourishment. The choice of antibiotic is a decision for you and your primary care doctor. Please contact their office for antibiotics or further advice. We are happy to discuss this with them should they need to contact us. If you have significant immune compromise, Type 1 diabetes mellitus, history of previous infected spinal fusions or joint replacements, hemophilia or malnourishment then we suggest antibiotic prophylaxis for ALL future dental procedures regardless of timing, but this again is something that needs to be resolved through your primary care physician and not your neurosurgeon. If there is any confusion please have them call us.