Dental appointment at hospital

[sue943]

I mentioned back in November (I think it was) that my dentist didn't want to do a scale and polish on me as he said I needed both oral antibiotics plus intravenous gentamicin which he isn't licenced to give so would refer me to the hospital for them to do it for me. Then I saw my cardiologist a few weeks ago, he said the hospital dental department had contacted him and he confirmed to them that I must have both oral and the intravenous antibiotics.

Today I went to the hospital to keep my appointment. The dental surgeon I saw said that he was MOST reluctant to do this as there were risks from the heavy duty drugs, both in adverse reactions but also in my body becoming immune to them so should I need treatment for serious infection in the future the antibiotics might be ineffective. He also said that even with oral and intravenous it wasn't 100% certain that I wouldn't still get endocarditis.

He said although I could do with a scale and polish he couldn't justify pumping me full of drugs every six months when the worst case scenario without a scale and polish was the possible eventual loss of a tooth or two, he asked what was worse, losing a tooth or my life.

We left it that he will look at me again in six months to see how fast I am accumulating tartar then decide then whether to take the risk.

Still, he was 'easy on the eye' so it will be quite pleasant to return to see him in six months.

 

[Susan BAV]

Dental/gum care is so important for us "valvers," so thank you for that information, Sue.

Reminds me that I must get in for another cleaning. I've been putting it off...

 

[hensylee]

goodness, Sue. I am sorry that they can't do it. I guess they will keep an eagle eye on it?

 

[Curtsmum]

Does't sound very good, hope you can keep your mouth healthy. We have been given plaque check disclosing tablets for our son to make sure he keeps his teeth as clean as possible, best of luck

 

[dick0236]

I assume that what you call "scaling and polishing" is what we call "cleaning". If so, it seems your dentist is ultr, ultra-conservative.
It is important for mechanical valve patients to practise good dental care. Over the past 20+ years I have been very attentive to dental care. I get my teeth "cleaned" twice yearly. I have had a number of root canals, crowns, extractions and periodontal(?) disease treatmements due to poor maintenance when I was younger. The only pre-care I have ever done is to take 2000 mg Amoxicillin one hour prior to the appointment. This amount is per the American Dental Assoc (ADA) protocal and is with full knowledge of my doctors. It is even a lowered amount from what it was several years ago. Unless you have something else going on, I agree with the hospital, your dentist wants to use a sledgehammer to kill a flea.

 

[sue943]

The hospital are not going to do the cleaning unless I have the cover, I have taken 3000 mg of Amoxicillon in the past but the dentist says I am just too high risk for that, and my cardiologist agrees so it isn't just my own dentist. The hospital dentist doesn't dispute the drugs, but is worried that I could end up with more problems - he thinks I am just too high risk and with my luck something will go wrong. I would add that I have in the past had tooth 6 absesses.

 

[Susan BAV]

Sue, I recall a member (I think it was Bryan B or Brian B) mentioning how beneficial rinsing regularly with Listerine is--for healthy gums and such. Hope that is helpful. Take care .

 

[sue943]

I bought some earlier today, I want to inhibit further tartar. Thanks.

 

[Magic8Ball]

I have taken Amoxicillin before my dentist appointments all my life.

My current dentist is great with the warfarin issue but even he says that you are at more risk of getting bacteria in your blood through your gums from eating an apple than you are from getting a filling.

As far as cleaning he still wants the Amoxicillin but not for normal checkups.

However, i insist on still taking it...just don't see any risk in continuing.

So i agree, your dentists seem ultra conservative on needing an intravenous injection of the stuff.

Time for a second or even third opinion....are you supposed to wait until you can't close your mouth for the plaque build up before they will do something ?

 

[tobagotwo]

While the US is not the final arbiter of all things medical, the ADA and the AHA do not recommend prophylactic antibiotics for fillings.

They have also removed people from the list of those who are recommended to take them (these are guidelines, not laws): http://www.ada.org/prof/resources/topics/infective_endocarditis.asp

The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients

Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of these everyday activities than from a dental procedure.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

mitral valve prolapse
rheumatic heart disease
bicuspid valve disease
calcified aortic stenosis
congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

The new guidelines are too vague for most people to be able to tell which procedures are involved. I offer this, from the old guidelines, that is easier to understand: from the American College of Cardiology, the American Heart Association, and the American Dental Association, in regard to when people would or wouldn't be using prophylactic antibiotics:

Table 2. Dental Procedures and Endocarditis Prophylaxis

Endocarditis prophylaxis recommended*

Dental extractions
Periodontal procedures including surgery, scaling and root planing, probing, and recall maintenance
Dental implant placement and reimplantation of avulsed teeth
Endodontic (root canal) instrumentation or surgery only beyond the apex
Subgingival placement of antibiotic fibers or strips
Initial placement of orthodontic bands but not brackets
Intraligamentary local anesthetic injections
Prophylactic cleaning of teeth or implants where bleeding is anticipated


Endocarditis prophylaxis not recommended

Restorative dentistry† (filling cavities) and replacement of missing teeth.(operative and prosthodontic) with or without retraction cord‡

Local anesthetic injections (nonintraligamentary)
Intracanal endodontic treatment; post placement and buildup
Placement of rubber dams
Postoperative suture removal
Placement of removable prosthodontic or orthodontic appliances
Taking of oral impressions
Fluoride treatments
Taking of oral radiographs
Orthodontic appliance adjustment
Shedding of primary teeth


† This includes restoration of decayed teeth (filling cavities) and replacement of missing teeth.

‡ Clinical judgment may indicate antibiotic use in selected circumstances that may create significant bleeding.

People whose valves have been repalced are still on the guideline's list of those who should take prophylactic antibiotics at this time, despite the fact that they find no evidence of their effectiveness. Amazing...
Best wishes,

 

[Shirley]

Yes, the dental guidelines have changed. They still recommend antibiotic prophylaxis for people with heart valve replacements. Yes, there is a risk from every day cleanings - brushing and flossing in that you are stirring up bacteria but when those cleanings are done daily that risk goes down to nothing. The greater risk would be if you didn't clean your teeth for a week and then went in to stir things up - the germs would be more dangerous. If you are ill and can't brush for awhile using a mouthwash before brushing will help decrease the bacterial load in your mouth.
The really bad germs in a mouth are the deep ones that don't require oxygen and that you cannot reach yourself with normal cleaning. For people with gum disease or periodontal problems it is essential for the hygienist to stir up those bad bugs so they do not cause further damage to your mouth and heart and that is why antibiotic prophylaxis is necessary. While stirring things up the hygienist also removes hardened deposits from the tooth ie. tartar, calculus. If you tend to have a lot of buildup brushing with a dry brush first and then with toothpaste helps a lot. Frequent toothbrush replacement also helps.
At this season of the year, also remember that you can clean your toothbrush by top rack placement in your dishwasher if it is a manual ie old-fashioned toothbrush and that gets rid of viruses and other cold weather germs.
Shirley

 

[marky]

Sue.. It sounds like your dentist and cardio are being very cautious.. which IS a good thing! they are staying on top of it.
It is true that the US has declared no need for antibiotics for certain valve patients, but my cardio said she still feels better for me to take them. In the past 3 months I have had a tooth extracted and a cleaning, both times I took the recomended amoxillin dose.

 

[sue943]

I think they arer taking into consideration that people who have artificial valves are high risk, also people who have already had endocarditis are high risk - which makes me very high risk.

 

[Blanche]

Sue:
Albert had endocarditis in early 1990 and he received his St. Judes Mitral valve in October of 1990.

Since then, he has received IV antibiotics, three times per year for regular cleanings as well as several other times for fillings, deep scaling, and more involved dental work. As a matter of fact, he has an appointment on February 21 for antibiotics followed by dental work.

The reason he needs thes antibiotics is because he is high risk. I cringe when he has to have more antibiotics, but without dental work his teeth would deteriorate and he would be risking all sorts of difficulties, including endocarditis again.

THere are lots of articles on dental work and good health. Perhaps your other doctors could find someone to help you with this. Albert's internist administers the IVs in his office for us.

Blanche

 

[sue943]

Other doctors are not an option, I live in a small island with one hospital, I have no option than to listen to them and to follow their advice. They are going to monitor it and re-assess in six months.