Antibiotics again

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Pegasus

Well-known member
Joined
Jul 18, 2006
Messages
191
Location
Montreal, Canada
Well, my husband (valve patient - mitral valve repair) just had his annual appt. with cardio (echo in May) and all is well which is great.
The dentist gave cardio a form to fill out as there are new guidlines for antibiotics use and cardio said nothing has changed and he should be on antibiotics for all dental procedures, even fillings. My husband is not a high risk patient and this is frustrating to us. He has been on more antibiotics since his OHS than in his entire life!
The dentist won't touch him without the antibiotics (I guess my husband could lie about it if he choses to) and the logic of the dentist is that the filling is close to the gum line. All his past fillings have been close to the gum line too and my husband never bled. The cardio said what if the dentist slips and cuts him? *sigh

It's not just the dentist it's all other doctors too. At one hand, I truly appreciate that they are taking the risk of endocarditits seriously on the other hand I worry about antibiotic resistance and I want decisions based on science and not on fear because everyone tells him to take the antibiotics 'just in case'.

Once antibiotics were given to him for a virus - AAARGH - his GP who wasn't there had a fit about that. He had numerous filings (his teeth are falling apart) and more fillings to come - all of them on antibiotics. He just got bitten accidentally by our German Shepherd (no bite intended just a collision :)) but it was a nasty and deep wound. It's healing fine but again he is 5 days on antibiotics. I didn't mind this time so much as my husband was run down a bit but I rather not have him go back on antibiotics next week for filings (they won't be done in one setting either).

If anyone has anything helpful to offer I appreciate it. Are all your doctors that cautious?? I will print out posts for my husband. I can't and won't make decisions for him although I really don't feel that antibiotics for fillings are needed. We don't want to switch cardio or dentist either, as they are really nice otherwise.
Thanks!
 
Hi--about the antibiotics. I have taken antibiotics pre cleanings at the dentist since I had my mitral valve replaced in 1997, and again in 6/2007. Over the years the type and amounts have changed. Now I have a shot of antibiotics 1 hour before the procedure and take 2 tablets of antibiotics also. And that is it. The shot is of gentimycin(sp). I used to have to take pills before and after for a few days. So the shot is great. My cardiologist is great and has helped me through so much so I trust his judgment on this too.
 
Yes, antibiotics can be frustrating no doubt about it.

Yes my Doctor insists taking these pills before ANY dental work is done. My Dentist won't touch me if I haven't taken the antibiotics.......his response "I don't want to get sued by you if you do get endocarditits".
 
Hello Astrid!
I don't remember if my (same) cardio brought this up in our last visit, but my dentist prefers that I take the 2 pills of clindamycine before ALL procedures. If a repeat visit is needed we book it a month later so as to not overload my system with the antibs.
I mean lets face it....the mouth is a cesspool of germs.....I will kiss my dog before most people!!
 
Thanks!

At least I will tell my husband to book 1 month between dental appt.

You are right, Bina, I'd definately kiss my dogs over most people too:) BTW, do you know that 'our' cardio has moved his office?

True, the mouth is a cesspool of germs but my husband flosses everyday and once or twice had cut himself with the floss and he bled. Before his OHS my husband was not on antibiotics - he was asymptomatic so he never even knew he had severe regurgitation. He was at much higher risk then, than he is now with a fixed valve. Oh well...
 
Congratulations to your husband on his excellent one year check-up. Glad to hear his mitral valve repair is holding up.

I also had a mitral valve repair, and am not considered high risk either. At my Cardio's recommendation I was taking antibiotics before dental work ever since my heart murmur was discovered. However, at my last Cardio post-op check-up (Sept '07) he told me I no longer need to take antibiotics before dental work. My Dentist defers to the Cardio's advice.
 
Thanks Wayne (and everyone else).
Acutally my husband has his 2nd anniv. soon. He is just a bit behind you. Congratulations to your 2nd anniversary and many more. I love to hear of lasting repairs!

You are lucky! Too bad your cardio and dentist are too far away :) Dentist insists there may be bleeding and needs to go on antibioticts. He goes in Monday. She always says he will bleed and he never does. We tried....
 
Yes, cardio has a nice new, hotsy totsy office!! I just care that it is a bit closer to my direction.:)
I've been taking antibs before dental for about 15-20 yrs; long time murmur and long time gum bleeds.
 
Joe took antibiotics before ANY dental work, even cleanings. It would have been tragic if he had gotten endocarditis. So, for him, it was a small price to pay.
 
Although my dentist says it is not necessary to take antibiotics for a filling, having already had endocarditis (which makes me more at risk), I think I would take them if I knew that the drilling would be near the gum line. Your husband does NOT sound like high risk since he did not have a prolapse (making the composition of the valve such that bacteria stick to it more easily - at least I think so). Now that he does not have the regurgitation, he sounds low risk to me. However, I am not a doctor. Also having had endocarditis, trust me, he doesn't want to get it!!
 
I saw my cardio yesterday for the first time since I got my new bovine replacement and he reminded me that I was to always pre-medicate for all dental work. He had me do that while in the waiting room and says valve replacement patients are the exception to the AHA recent pronouncement. If my cardio says to take amoxy., I take it. Period. I understand about too many antibiotics etc but think the risk of inhfections too great and the antibiotics worth it. Not a big deal to take a few pills a few hours before I go to the dentist.
 
Pegasus:

My husband says that our cardiologist has told him to ALWAYS take antibiotics before ANY dental visit. John has a repaired mitral valve and has never had any dental work done, other than cleanings, in his life.
Dr. Tobey said to always take antibiotics, even if the dentist says no. (And I don't think our dentist will say to forgo the antibiotics.)

I carry amoxi & ceph in my overnight bags, in my briefcase I take when I judge cat shows & in my grooming bag when I show my cats.
I recently got nipped by a cat who got too excited over a cat toy I was using on the judging table. It wasn't the cat's fault; it was mine. I should have remembered that two things cannot occupy the same place at the same time.
There was very little blood drawn. But I cleaned the puncture marks and gulped down 4 500mg capsules of amoxi, for whatever it was worth.
Anyone who is bitten or scratched by a cat (or dog) should take antibiotics immediately. Animal bites/scratches can turn nasty.
 
>>JKM said: I saw my cardio yesterday for the first time since I got my new bovine replacement and he reminded me that I was to always pre-medicate for all dental work. He had me do that while in the waiting room and says valve replacement patients are the exception to the AHA recent pronouncement. >>

Actually VR patients aren't the exception, but they were not included in the recently "ousted" conditions. (MVP, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, ventricular septal defect, atrial septal defect & hypertrophic cardiomyopathy)

The AHA/ADA still recommends antibiotics for artifical valves (tissue & mechanical), History of IE, Certain specific serious congenital defects.
 
Better safe than sorry

Better safe than sorry

In 1990 my husband got endocarditis from dental work....the same type of dental work that he had been getting for 40 years. The infection attacked his heart valve. As a result, he became the owner of a mechanical St. Jude's Mitral valve.

Medicating before dental work is not only a good idea, it is mandatory with the few dentists that I know and a whole lot of Cardiologists and internists.

It is my understanding that the threat of endocartitis comes from all of the "stuff" stirred up during the dental work, including the ground up rotten material from cavities or the plaque that is removed during cleanings.

Wishing you the best,
Blanche
 
Adrienne, he did have a prolapse with severe regurtitation (from a ruptured chordae). His repair was pretty straigth forward.

Obviously, it would be disastrous to get endorcarditis so he will take the antibiotics. However, he was on antibiotics about 8 times last year which can't be good either. It was mostly for fillings and caps and there was no bleeding. They didn't seem to specify mitral valve repairs with annuloplasty ring in the studies but I guess since it is a piece of plastic (I think) it could be a risk.
Thanks.
Astrid
 
Pegasus said:
Adrienne, he did have a prolapse with severe regurtitation (from a ruptured chordae). His repair was pretty straigth forward.

Obviously, it would be disastrous to get endorcarditis so he will take the antibiotics. However, he was on antibiotics about 8 times last year which can't be good either. It was mostly for fillings and caps and there was no bleeding. They didn't seem to specify mitral valve repairs with annuloplasty ring in the studies but I guess since it is a piece of plastic (I think) it could be a risk.
Thanks.
Astrid
Click to expand...

What I meant but didn't explain well is that your husband's prolapse was from an accident (wasn't it?). He did not have the kind of prolapse which is caused from myxomatous (sp?) tissue.
 
I've been taking antibiotics for all dental work, on instructions from the docs and the dentists, for what seems like forever -- 30 years maybe, or more. I just do it and don't worry about it.
 
It is NOT recommended for a patient to have antibiotics for a filling.

An enormous study, including 50 years of prophylactic antibiotic use data, showed no indications that prophylactic antibiotic usage lowered your chances of getting bacterial endocarditis by the tiniest nit.

However, the doctors are holding onto it for a few years longer for their more advanced patients, because many of them believe in it so strongly and blindly that they may sue just to have access to it. And they're also keeping it around for a while because it is just brutally embarrassing to admit that all these learned doctors have participated in an unchallenged folk myth for over a half a century.

So, to perpetuate the myth...What dental procedures are they recommended to be used for?

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 more concise and 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.
Click to expand...

You'll note that pre-work antibiotics are specifically NOT recommended for fillings. And that's form the guidelines BEFORE they loosened things up. Your dentist is covering his wide behind at his patients' possible expense.

Best wishes,
 
In December I had a crown and dentist had me take antibiotics as usual. Just last month I had an old filling replaced and he said I didn't have to take antibiotics as per the new guidelines. I called my cardio and he concurred.
I am glad as antibiotics always mess my digestive system up so bad for three or four days even when I eat yogurt. But they both said it was still reccommended for root canals and other oral surgery.
 
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