Visit to the dentist today

[sue943]

Today I had my appointment at the hospital dental department to have my teeth cleaned. As per the agreement on my last visit I took my 3 grams of Amoxillon an hour before.

Before he started work the dental surgeon told me that last week the local cardiologist gave a talk to dentists in this island about endocarditis. He told them that guidelines or no guidelines, endocarditis is a nasty illness and anyone who has had it once will be most reluctant to put themselves at risk of getting it again so if such a patient requests antibiotic cover then the dentist should give it to us for our peace of mind, regardless of whether it is medically considered unnecessary or effective. Bravo to him, I think I like him.

Naturally I bled quite a lot during the cleaning, my INR was 3.6 when last checked, and the dentist said that seeing that amount of bleeding made him glad that I had the antibiotic cover, that he would have felt very unhappy for me not to have had the antibiotics. So the antibiotics are for his peace of mind too.

I now have to go back in three weeks to see if there is any improvement in my gums, and then to probably have another deep clean in three months.

The dentist also said that he was very impressed with my knowledge of my condition, of replacement valves, anticoagulation etc.

 

[LUVMyBirman]

Hi Sue,

Sounds like you are on top of things.

I don't agree with the new guidelines for patients that may have, say, MVP without the replacement. I was speaking to a dentist that had BAV and did not take the pre-meds on the new guideline platform. Wanna guess what he got? Yes, endocarditis. I am sure it's a matter of time before he's in for surgery.

Family member of mine has MVP with very mild reguirg. I refuse to have treatment completed until the pre-meds are taken. I have been challenged on that point. I know too much of what can happen if you don't pre-med.

We also have a number of members on VR that have contracted endo through cracked teeth and other dental issues. So what does that tell me? Bacteria enters the blood stream. So why not CYA? I feel they will reverse the guidelines. This is all so frustrating!

May I ask why you take 3gr? Has that been upped from 2?

 

[skeptic49]

I feel they will reverse the guidelines.

Good thread!

I was just re-reading the revised guidelines this morning. I had a colonoscopy on Monday...which resulted in a single plolypectomy...and, of course, the new guidelines do not require pre-meds for these sorts of procedures so I have not been doing pre-meds since the guidelines changed.

They make a strong case for the revision. The primary argument is that so few cases of endo are actually prevented by pre meds that the benefit is out weighed by the down side effects, e.g. the develpoment of resistant strains of bacteria, cost, etc. Of course, if you are one of those who gets endo then their arguments don't help much.

I will have to reconsider the issue going forward.

Jim

 

[sue943]

I have always taken 3 grams, in fact I had a scale and polish at my dentist's office and he had me on two lots of antibiotics, the 3 gram dose then a five day course of two antibiotics, this was several years ago.

As someone who contracted endocarditis after not being given antibiotics prior to lithotripsy I would have refused treatment without some sort of cover.

I am happy that both my cardiologist and dental surgeon are prepared to give me antibiotic cover regardless of guidelines.

 

[Bina]

I was at my dentist yesterday for a good cleaning. I've been taking preventative antibs for the last 25 years, and I see no reason not to.
It's only one dose, no big deal. I take clindamycine.

 

[Lynlw]

I have always taken 3 grams, in fact I had a scale and polish at my dentist's office and he had me on two lots of antibiotics, the 3 gram dose then a five day course of two antibiotics, this was several years ago.

As someone who contracted endocarditis after not being given antibiotics prior to lithotripsy I would have refused treatment without some sort of cover.

I am happy that both my cardiologist and dental surgeon are prepared to give me antibiotic cover regardless of guidelines.

Sue I know you don't live in the US, but our guidelines call for anyone with a previous case of BE to always get the antibiotics. My guess would be others still recomend it too

 

[olefin]

I've taken 2000 MG of Amoxicillin one hour before all dental procedures for many years. Before that, it was required to be taken IV. Sometimes a nurse would come to our home or other times I would go to the hospital. The pills are a snap!

My gums bleed a little for several hours after cleaning.

Last month my INR got up to 5.4. The next day I bit the end of my tongue... BIG time! It bled pretty bad for about 24 hours even with me holding tea bags on it. Wife got a laugh seeing me holding the tea bags on the end of my tongue.
The next morning my pillow was soaked with blood form me sleeping on my side.

 

[Nupur]

im, you were courageous to go through colonoscopy without antibiotics. I am not comfortable with the new guidelines. Here's my friend with suspected mitral valve prolapse getting meds for dental cleaning for years, and I can't. I went to the dentist and I was very nervous about it. It turned out that the dentist thinks I have an infected tooth and gave me a prescription for Penicilin for that, which I just filled. However, after this dose, I also go back for a root canal. And I am wondering if I should get more antibiotics? I wish pre-surgery people could get routine anti-biotics too! I am totally scared of endocarditis after reading all the stories here.

 

[ponytaila1a]

My dentist would not clean my teeth without the anitbiotics. The cardio wrote an "order" and signed it that I did not need them. The dentist wrote the RX, had me take them anyway. I felt more comfortable. It seems you would have to take an extremet amount for you to become immune....my opinion. Do not like the new guidelines!

 

[CathyK.]

I have always pre-med before the dentist as soon as I found out I have heart problems and still pre-med. I didn't however, pre-med before my colonoscopy. Didn't think about it and neither did any of the doctors.

 

[Bryan B]

Anyone who has heart valve disease should be given preventative antibiotics before a colonoscopy in case they need to remove polyps during the procedure. I had my first colonoscopy 9 months after my Ross Procedure and they gave me Gentamicin and Cefazolin IV when I was being prepped for the procedure. They have to start an IV anyway to give you "happy juice" to sedate you. They just started my IV as soon as I got there so they could get the antibiotics in my system before they started the procedure. I ended up having 2 polyps removed so I'm very glad they gave me the antibiotics. Of course I was diagnosed with endocarditis 14 months earlier and had my Ross Procedure 9 months earlier. Now days most doctors won't even look me in the eye unless I have pre-medicated.

 

[ALCapshaw2]

Guideline Clarificaiton -

While the NEW Guidelines state that antibiotics are not needed for 'most' patients, they also state that for patients who have an Artificial Heart Valve, antibiotics are still recommended.

'Al Capshaw'

 

[roundsgirl]

I've had a colonoscopy and the light ran down my throat, forgot what that is called; anyways they did biopsies both times, but the doctor told me I didn't need anitbiotics for either of these procedures. This was after my OHS, little did I know I always thought it was just before dental procedures.
Oh well you live and learn I guess.

 

[lance]

No matter what guidelines say I will take meds prior to dental work as usual. Technician always asks have I taken them. They're very careful and my PCP insists on it.

So my teeth are routinely scaled every three months, bleeding minimal and brief.

 

[sue943]

The hospital dental surgeon told me that strictly speaking they ought to consider root canal fillings as potential problems, he said if they were being VERY careful they might consider it necessary to remove all the teeth which I have had root filled! I yelled and said "No Way!" so it is noted that I refused to consider that option - it is in my notes that he suggested it and I refused so their backs are covered. I don't think he was seriously suggesting that I had it done, he was just covering his back. When I was in the UK with endocarditis they sent me to the dental department of that major hospital and x-rayed my mouth and jaw and said there wasn't a problem with my mouth and if they didn't suggest removing the root fillings then that is fine with me, they are the experts rather than my local hospital dental department.

He did say that a couple of the molars on the right are loose and are not going to be with me much longer. I don't know what will be involved in the removal of those, whether I will need to come off the warfarin, I suspect it might be possible in which case it will be an stay in hospital as they take my INR down and raise it again.

 

[lance]

This info might be helpful

This info might be helpful

Hi Sue
Following valve replacement surgery (maybe 4 years ago) an abcess developed in a rear molar requiring root canal. I was in a lot of pain and on antibiotics and of all things oxycontin. The root canal was done while I was fully anticoagulated. Everything is fine without any threat of tooth removal from either of my dentists.

Before I was on warfarin I had 4 impacted wisdom teeth removed. In each case the tooth was cut in quarters and the pieces gently removed. There was not any swelling and the only discomfort was the taste of blood for a day or two. The sockets were sutured. I read somewhere (probably here) that some dentists are removing teeth without holding warfarin. That's a good thing.

Hopefully things work as well for you.

 

[lcwhitney]

For me I pre-med with any thing that involves any mucous membranes and blood or the possibility of blood contact during theprocedure.My cardiologist even had me pre medicated with GENTIMYCIN AND VANCO MYCIN PRIOR TO MY HYSTER ECTOMY IN 1996.

lETTITIA