Hi - I have a question regarding dentist/hygienist and the need to take antibiotics afterwards (newly diagnosed with ET/JAK2 and still bringing down platelets with Hydroxy). My haematology team recommend antibiotics after any major work, and for the dentist/hygienist not to use too much pressure. The dentist is suggesting antibiotics after any hygiene treatment, as this involves cleaning under the gum line. This would mean antibiotics every 4 months (3 visits a year). I will go back to our MPN team to confirm if they mean hygienist work, but I’d like to find out what other people do. Do you have antibiotics every time you go to the dentist/hygienist, or when do you take antibiotics as a precaution?
Thanks
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I am in the United States and my dentist said I do not need to stop Hydroxyurea, Eliquis, or take antibiotic before routine dental cleaning. When I first had knee replacements I had to take an antibiotic a couple hours before cleaning, etc. I stopped this after the American Dental Society said it was not necessary,
I have not had more than normal cleaning so I would bring this up if I have any other procedure scheduled.
I have never heard of antibiotics being needed after routine dental work while taking HU. The exception would be if your leukocytes are severely depressed due to the HU. I would expect if that was the case then your treatment plan would have been changed.
Unfortunately, antibiotics are one of the most over-prescribed medications. When needed, they can cure infections and possibly save your life. When not needed, the risks outweigh the benefits.
Your dentist will know little to nothing about MPNs and hydroxycarbamide. This question is outside of the scope of practice for a dentist. Suggest you follow instructions from your MPN care team.
Thanks - I don’t approve of taking antibiotics unless absolutely necessary, so I was looking for others to say they don’t need them to feel more confident going back to MPN team and asking them to make it clearer for my dentist
I found that once I had explained to the dentist that I had a reduced immune system due to blood and bone marrow cancer, he decided on least invasive treatment as possible himself. The 6 monthly exam was the same but the cleaning and descaling was much less intense
The ZOE podcast (with the UK’s excellent Prof Tim Spectre and US medical director Dr Will Bulsciewicz) just did an excellent podcast about antibiotic use, the effects on gut health and how to recover good microbial diversity after their use (or mis use!). Solid, well researched advice. So for anyone who does need antibiotics, because our various microbiomes are so intimately tied up with our general immune health and inflammation levels, this is a good one to listen to.
Hi ! It has never been suggested by dentist or MPN consultant to take antibiotics before or after dental treatment . Am also in UK. I see a private dentist. I saw the dentist and hygienist 4 months ago. Teeth all my own . Not bad going for an 80 year old!
Thanks Dusty! good dental care from the age of 5 overcame all the sweets and soft drinks I consumed. My parents were blest with a fine set of gnashers!
No never had antibiotics unless you get an infection in gum . I sometimes have injection but never need antibiotics . I don’t want anymore drugs inside than the necessary one . 👍
Hi. I’ve never been given antibiotics as part of routine dental care. When I needed some reconstructive work after rearranging my teeth in a fall (:(( ) and required some heavy duty cleaning out etc I know the dentist injected me with antibiotics (and I might have had to take some orally too - can’t recall). But that was a standard intervention due to the dental procedure and not because of my PV.
They were certainly aware the potential clotting and particularly, bleeding risks and as I recall I stopped aspirin a few days before they did the work. I certainly wouldn’t be in a hurry to swallow down more antibiotics than strictly necessary!
I am a dentist and my wife has PV and is also a dentist. We do give prophylactic antibiotic cover to a small number of patients prior to certain dental procedures that are likely to cause bleeding. This includes any oral surgery or extraction, vigorous cleaning (normal routine cleaning doesn’t need cover), and occasionally root treatment. Normal fillings, local anaesthetic injections, crowns and other routine treatments don’t require antibiotic cover at all. The patients that need cover are those that are at risk of getting a bacterial endocarditis (BE), which is where the heart itself becomes infected with bacteria that inhabit the mouth. This is life threatening and hence taken very seriously.
Those people at risk tend to have significant cardiac pathology which predisposes them to getting BE, such as having had a mechanical valve replacement or may have previously had a BE. Joint replacements do not require antibiotic cover for dental treatment.
The question as to whether MPN patients need antibiotic cover is generally no. Certainly not for routine treatment and cleaning. I would want to discuss the issue with your haematologist because they may have some specific reason for wanting you to have cover.
The important point with antibiotic cover for dental work (if required) is that it needs to be taken as a single large dose one hour before your dental appointment. This is because what we are aiming to do is kill off as many of those pesky bugs as they enter your blood stream, which is when we are actually performing the procedure. We do not ever give an ongoing course of antibiotics after the treatment because there is absolutely no need.
Having said that, of course we do prescribe antibiotics- very sparingly these days echoing Hunter’s comments about antibiotic overuse.
Talk to your haematologist and your dentist. Having antibiotic cover every 3-4 months for hygiene appointments is not appropriate.
Hunter is right - dentists don’t even know what MPN stands for!
Thank you. Our Haematologist suggested antibiotics for major work, and dentist interpreted as including hygiene as visit includes below the gum work. However except for ET there are no other conditions (healthy weight, heart etc). So we will ask MPN team to make it clearer to the dentist.
My pleasure. Sure, if you get a dental infection and need root treatment or extraction/surgery then antibiotics may be appropriate but other than that I can’t see where they would be of any benefit. Regular check ups and hygiene are definitely the way to go - you are preventing dental issues and getting them sorted when they are minor and simple to fix.
Wonderful advice - Thank you. Im 59, with ET and having a"difficult extraction" x1 with a Maxfax surgeon soon, with cavader graft and implant. Like many, have 'significant bone loss', probably due to ET.I had rather hoped he would do it as local day surgery, in public hospital, NZ, but mainly because Im a bit nervous, and would prefer GA rather than just Midaz. I also work there as a peri op nurse, know a bit much at times.
My experience is a bit different than mentioned here. I'm healthy, 76 and had a heart valve replacement 5 years ago, and 2 knee replacements over the last 8 years. Both my cardiologist and orthopedic surgeon as well as my dentist insist on 1 round of antibiotics prior to any dental work. Frankly it seems like a minor precaution given the admittedly minor risk. We're taking HU which is way more problematic.
Interesting to read your query as I have ET too! I have not been given this advice but intend to ask. There are staff problems at my hospital in Scotland - all the Haematology consultants have left so my Haematology nurse is struggling to cope!
Hi, the only reason I take antibiotics 1 hour before any dental procedure is because I have recent surgery for two shoulder replacements. Definitely not for Jak 2 + ET or HU.
Definitely discuss with your hematologist and have him contact dentist.
I have never taken antibiotics after dental treatment and I have been absolutely fine I have ET/Jack2 and I am taking Hydroxy plus baby aspirin hope this helps xx
Hi, I have never had antibiotics after hygienist or dentist appointment. My husband is a dentist and he has really been going in deep to see what is best for me. But as suggested, talk to your "people", they know you best.
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