Dental work and antibiotics, again

[Nupur]

MattWisconsin, you got your endocarditis unrelated to dental work though, right? Or did you have dental work close to when you got infected?

I feel concerned about taking anti-biotics irresponsibly and contributing to superbugs, but I still want to be safe.

 

[Eva]

MattWisconsin, you got your endocarditis unrelated to dental work though, right? Or did you have dental work close to when you got infected?

I feel concerned about taking anti-biotics irresponsibly and contributing to superbugs, but I still want to be safe.

Nupur,

It is safer to take them and you won't be exposing yourrself to superbugs unless you take lots of them all the time! I had been taken them since 1984.

As for the new guidelines, I asked my dentist when I took my sister last week if the protocol has changed...he still recommends the premedication.

I would be concerned if you did not take them at this stage.

 

[Eva]

Nupur,

For your peace of mind, I am quoting this which is a repeat of what Braveheart quoted:

"Only the people at greatest risk of bad outcomes from infective endocarditis ? an infection of the heart's inner lining or the heart valves ? should receive short-term preventive antibiotics before common, routine dental and medical procedures."

Unprotective valves will get more infected and the infection may lead to endocarditis then!

Don't be hesistant about it!

 

[mattwisconsin]

I hope I wasn't unclear. I am for the antibiotics.

I don't know exactly where the endocarditis came from. I did not have dental work anytime associated with the infection. My infectious disease doctor said that it was a bacteria common to the mouth and could have gotten in at any point, such as bleeding gums while brushing my teeth. So they still don't know how I got it.

 

[Eva]

I hope I wasn't unclear. I am for the antibiotics.

I don't know exactly where the endocarditis came from. I did not have dental work anytime associated with the infection. My infectious disease doctor said that it was a bacteria common to the mouth and could have gotten in at any point, such as bleeding gums while brushing my teeth. So they still don't know how I got it.

Matt, I agree with you as among the instructions I was given before discharged from hospital is not to use toothpicks, no hard electric toothbrush, and only to use waxed dental floss, to avoid the possibility of what you mentioned!

 

[ruthienc1]

After the guidelines changed- and prior to my AVR- I gave myself a break from them. I was truly unaware of the endocarditis risk, but fortunately, had no problems. After my AVR I was told, in no uncertain terms, to always premedicate- which for me is Clindamycin (which makes food taste awful for a day )

 

[debster913]

I've always premedicated with everything from penicillin to amoxicillin, and now Biaxin. My cardio says that I'm still at high risk despite the new AHA guidelines because my annuloplasty ring is just like having a mechanical valve--it's a prosthetic item in my heart, and therefore I need to protect myself by taking my antibiotics.

However, I absolutely HATE Biaxin. The stuff makes me sick to my stomach. Last week I had my teeth cleaned, and I felt nauseated + tons of PVCs for hours. After my cleaning, I went home to sleep. No offense, but sometimes it gives my diarrhea, too. I'm trying to work with my cardio to take something else.

Anyway, despite the horrible nausea, I'd rather take my 'biotics than run the risk of a valve infection...because knowing me, the one time I wouldn't take my antibiotics would be the day I'd get an infection.

 

[Jkm7]

After two heart surgeries and a bovine replacement (which I recognize is an exception to the 'no need to pre-medicate' new opinion) there is no chance any dentist or doctor is going to tell me to not pre-medicate. I understand about overuse etc, but I will never take the risk.

 

[deano89]

have just met with another dentist and she has agreed that i should be medicated ,her interpretation of the guidelines are if a patient requests it and there is a risk of endocarditis and the patient understands the risks of anatholatic shock then its ok
so needless to say i am moving dentists ,she did also add i should not undertake any uneccessary work ,i am so relieved !!

 

[olefin]

I always take 4 500mg amoxicillian 1 hour before any dental procedure. Our dentist provides the prescription.

Years ago after AVR I had to take antibiotic by IV before dental procedures. Some times a nurse would come to our home or I'd have to go to the hospital. Sure was glad the to when they changed the guidelines to oral.

 

[laurad37]

I am been taking antibiotics for dental work all my life

 

[tobagotwo]

The ADA Perspective

The ADA Perspective

From the ADA website (boldings mine):

The American Dental Association participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines were also endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.

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. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.

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 aimed at patients who would have the greatest danger of a bad outcome if they developed a heart infection.

Preventive antibiotics prior to a dental procedure are advised for patients with:

artificial heart valves
a history of infective endocarditis
certain specific, serious congenital (present from birth) heart conditions, including
unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
a cardiac transplant that develops a problem in a heart valve.

The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs.

The full report is available below, along with supporting charts and information. If you have any questions about these guidelines, please feel free to contact the ADA Division of Science via e-mail or by calling the Association’s toll-free number and asking for x2878.

Further:

Patients and their families should also ask their health care providers careful questions anytime antibiotics are suggested before a medical or dental procedure.

The AHA guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.

As your profile says you have mitral prolapse, and haven't received a valve yet, the guidelines argree with your cardiologist. And so do I.

Best wishes,

 

[pnwcoast]

My cardio has not, until now, been asked to consider this question concerning me. The outcome of my request for antibiotics before a dental procedure are "of course" "we will get a prescription to your pharmacey and a letter to your Dentist right away"

 

[aussigal]

I am no expert here but also agree with Bob H...

Here is how it was simply explained to me by my Cardio...(this was for my sons who have a BAV but no operation as yet..I have had the OP so my rule is different)
If the procedure does not carry the possibility of bleeding then you are safer than when you brush your own teeth. If it likely involves bleeding then pre-medicate.

 

[deano89]

i think the over riding factor for me is ,they have with drawn antibiotics with out really knowing what the consequences will be my !. i would rather be safer with antibiotic cover , after all i have had this cover for 24 years before the new guidelines came in

what have they based the withdrawal on? are we the study group? or should that be Lab Rats

 

[patchycat]

Antibiotic cover its cool

Antibiotic cover its cool

I have been taking antibiotic cover for dental work for almost 50 yrs. My dentist prescribes 3grams of amoxicil I take it an hour before the treatment. Its ok for a scrape and clean but any drilling and I need to have my cover.
I got a form for the Dentist to fill in saying I had no dental work to be done before surgery. He gave me a scrape and clean and said I would be Ok and he would do the other stuff after the surgery.
When the Hospital got the form saying the Dentist would do the other stuff after the surgery they took me off the operating list and didn't tell me. So I turn up at the post op clinic with out having the op. The specialists got really upset and started going on about my position on the operating list. My Dentist gave me a total filling replacement before the op. I got some infection in my throat after the Mitral Valve replacement none in my teeth.

 

[KristyW]

Its ok for a scrape and clean but any drilling and I need to have my cover.

Patchy...you have it backwards... a scrape and clean is the absolute dirtiest thing we in the dental profession do. Cleaning and extractions stir up a lot of harmful bacteria. A filling on the other hand does not unless it's at or below the gumline. The most important time for antibiotic cover is for cleanings and extractions. Even root canals are not that important as the dentist works entirely within the tooth. No bacteria stirred up in the bloodstream.

The issue is bleeding and the gums...NOT TEETH!

 

[Blanche]

I agree with KristyW

I agree with KristyW

My husband had endocarditis in 1990 that was traced directly to having his teeth cleaned.

Just how this happened, nobody knows. For as long as I can remember, he got his teeth cleaned twice a year with no problems whatever. Then, up jumped the devil. The endocarditis went undiagnosed for a long while and this resulted in hospitalization for 10 days. Then, he was on IV antibiotics, at home, for a month. And, several months later, he received his St Jude's mitral valve.

Blanche

 

[tobagotwo]

... they have withdrawn antibiotics without really knowing what the consequences will be

Actually, the practice of giving prophylactic antibiotics itself was instituted without knowing what the consequences would be. There was no scientific fact behind the idea. It just sounded like a good idea at the time, and it caught on. Its effects had never been actually researched before the recent, 50-year study.

... had endocarditis ... that was traced directly to having his teeth cleaned.

Again, it begs the issue. Taking the antibiotics has been shown to be ineffective in stopping this from happening. Also, as detection was delayed, they could have determined that it came from mouth-borne bacteria (common), but not that it was from a cleaning: it could have been from anytime he cut his gum, brushed his teeth, or ate something as well. It's now generally recognized that daily events cause far more infectious endocarditis than cleanings or dental procedures.

The AHA guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.

The pointlessness of taking prophylactic antibiotics is so real that the ADA has a segment on the professional side of its website designed to help dental professionals explain to reluctant patients when and why it's no longer being done for most patients. This has been made more difficult by financially interested parties using the fear-uncertainty-doubt technique to push dental professionals and cardiologists to have this small but continuous money pump kept in use. I know my dentist is petrified that he might be the cause of someone's endocarditis. Most feeling human beings would be.

Those who've had valve replacement are still on the list for premedication. However, I believe this is a step-down procedure, negotiated to get the process started and to begin gaining acceptance for a general dismantling of the practice. It will be a few years more before valve recipients are finally removed from the list for this medical rabbit's foot.

Best wishes,

 

[KristyW]

Bob is spot on!

As most of you know, I work for a dentist. We have adopted the new guidelines, but we still let the patient decide. I'm having great difficulties with my hygienist..."I don't want to be the cause of a patient's death because I cleaned their teeth without antibiotic coverage." No matter that there's absolutely NO PROOF that premedicating PREVENTS anything. Antibiotics are for fighting bacteria that are attacking...not for "waiting to see if a baddie shows up".

I follow the guidelines myself as my DDS and hygienist won't work on me otherwise, but if I had my druthers...I wouldn't take them.