Need support

Maako,

Unfortunately, the Standard of Care for Thalassemia only supports dental prophylaxis for splenectomized patients.

14 Dental Evaluation
The teeth can be significantly affected in patients with
thalassemia, but proper transfusion therapy can prevent
many of the changes. However, close dental and orthodontic
monitoring is crucial. In addition to regular
annual dental care, thalassemia patients should be evaluated
by a dentist to determine if bony changes requiring
orthodontic treatments have developed. If orthodontics
are recommended, they will be covered by insurance,
since their necessity is disease-related.
Furthermore, splenectomy can complicate dental care
due to increased risk of infection. Prior to dental work,
which is likely to cause bleeding of the gums, splenectomized
patients should receive dental prophylaxis.
Recommended treatment is 50 mg/kg of amoxicillin (to
a maximum dose of 2 g) one hour prior to dental work.
If the patient is allergic to penicillin, 20 mg/kg of clindamycin
(to a maximum dose of 600 mg) should be
administered one hour prior to procedure.

I can't say I agree with this, and we have talked about this before at http://www.thalassemiapatientsandfriends.com/index.php?topic=842.msg6388#msg6388  In this thread, Danielle mentions her friend who died after dental work.

Are there guidelines used that would support antibiotic prophylaxis for all thal patients? What are people told at their thal centers regarding taking precautions for dental work?

hi Andy,

thank you for ure reply..

I can't say I agree with this,

, did u meant to say u dont agree with that the treatment shud be given to every thal? or to thals only with splenectomy?

I talked to Dr. Farzana at and she too recommended i take the antibiotics before i go for treatment as i have some canker sores on my gums even now.. ..

i know about the topics.. even the one manal posted, saying that even a simple dental procedure shud be done with these precautions.. but i wanted proof (as in scholarly articles or research materials)..

i think am going to try another dentist again...

=maako=

Maako,

I did mean that I don't agree with limiting preventive treatment to only those with no spleen. I really think it's wise for all thals to take this precaution. Death isn't a risk worth taking.

Maako,

Dr Farzana is your doctor. If she prescribes something, other doctors should not be questioning that.

Maako

The best thing is to let your dentist talk to your doctor over the phone. This is actually what i did because at the beginning the dentist also said that only heart patients take the antibiotic cover, but after they talked over the phone, the dentist always make sure the my son is covered even if she is doing a smiple cleaning

Andy
I thought that the antibiotic cover is for thal with low hb only (in addition to splenctomised) because of their compromised immune system (due to low HB), so a bacterial infection couuld be life threatening to them compared to other non thal

But for a thal major with a high hb (especially after the transfuion), doesn't this put him/her in the category of non thal in terms of dental work. correct me if i am wrong

manal

Manal,

I think all thals should take this precaution but the guidelines do not recommend this. Danielle lost a 19 year old friend who had dental work done. I don't agree with doctors who think the chances are too slim to bother with this prevention measure.

I really would like to hear from people outside the US to see what the local recommendations are.

thank u, Andy and Manal,

yup, i think i better let my doctor talk to her instead of changing the dentist each time.. i'll give it a try.. hehe..

=maako=