Post-transplant Dental Antibiotic Use
Prophylactic use of antibiotic Rx's for transplant recipients before and after dental work is a common practice. What is your experience?
Do you premedicate prior to dental visits? Since my first liver transplant back in 1993, I have taken the same dose of amoxicillin – four 1,000 mg capsules an hour before and two 1,000 mg capsules four hours after - over all these years, regardless of whether the appointment was for a simple checkup and cleaning or something far more aggressive. In a world of transplant and Covid complexity, this seemed to be one of the few no-brainers on my medical to-do list. Until last month!
My long-time dentist’s retirement necessitated finding a new one, and I was delighted to find a husband/wife team much closer to my home. Oddly, both trained at the same university where my transplant center is. At my first check-up and cleaning, the dentist asked what premedication I took prior to the visit. He looked surprised when I told him the dosage schedule and said, “You seem to be overdosing. Call your transplant center and see why they still want you on so much Amoxicillin.” I emailed one of my transplant doctors and waited for a reply.
Curiosity got the best of me, and I emailed some liver transplant friends throughout the country, most of whom I’d met at the Transplant Games and asked them how they handled their dental visits. The dosages varied widely, and this seemed entirely appropriate given we all are in various stages of our transplant journeys, not to mention different ages, susceptibilities to disease, etc. What really surprised me were the responses saying their transplant centers had never told them anything about premedicating prior to dental visits. One said, “My dentist knows I have a new liver but never brought up premedication at our appointments.”
The next day my Transplant Center replied saying, “We’re now following the American Heart Association guidelines on this, and for routine dental care and cleaning, no antibiotics are necessary. Some dentists, depending on their comfort level, may at their discretion give antibiotics. Amoxicillin is okay and remains the standard of care for the more invasive procedures such as root canals, implants, etc.”
I brought up the topic at our San Francisco Bay Area chapter’s monthly meeting, and our lung recipients were all taking large doses before dental work, but nobody but me was taking it afterward. The necessity of antibiotics prior to cleaning teeth varied over the map. If you have too much time on your hands, go to the American Heart Association website and try to figure it out!
What should your takeaway be from this? I suggest if you’ve been on the same premedication dosage for dental work for many years like me, that you check with your transplant center to see if it still is appropriate for you. Obviously, get your dentist’s perspective as well. Have you had any unique issues with premeds prior to dental work? I’d enjoy hearing from you.
Steve Okonek (okoneksteve@comcast.net) was formerly the Vice President of TRIO National and is currently a member of its Board of Directors. He was formerly president of TRIO’s San Francisco Bay Area Chapter and remains active there.
