Antibiotics Before Dental Procedures

[Guest]

There is a big push in the world of medicine now to do things that have proof that they are of benefit and not do things that have no proof that they are beneficial. This is called evidence-based medicine. There is a dental journal published in the UK called Evidence Based Dentistry. Their latest edition contains the following article that discusses whether or not there are properly-done studies that find for or against using an antibiotic before dental procedures. I have copied the conculsions from the abstract below.

Is penicillin prophylaxis effective against bacterial endocarditis?
by Robin Seymour.
Conclusions There is no evidence about whether penicillin prophylaxis is effective or ineffective against bacterial endocarditis in people at risk who are about to undergo an invasive dental procedure. There is a lack of evidence to support published guidelines in this area. It is not clear whether the potential harms and costs of penicillin administration outweigh any beneficial effect. Ethically practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.
Evidence-Based Dentistry (2004) 5, 46. doi:10.1038/sj.ebd.6400258

So it seems that somebody a long time ago thought that prophylaxis would be a good idea and ever since then we've always done it that way.

Also, this study was done in The Netherlands. They probably have the best-organized anticoagulation management in the world. The national government provides health-care and everyone on an anticoagulant is assigned to an anticoagulation management service.

 

[ALCapshaw2]

What about all the VR.com members who acquired Bacterial Endocarditis from Dental Procedures WITHOUT premedication?

I guess the argument can be made that there is NO PROOF that pre-medication would have prevented the infection.

Sounds like a CRAP GAME to me, or at least a lot of CR*P...

I can understand the push for Evidence Based Medicine, but you won't see me skipping my pre-medication because of some Evidence Based Hypothesis. I would want to see better evidence that pre-medication does NOT provide protection. How are they going to test for THAT?

'AL Capshaw'

 

[fyrfytr]

Hey Al,
Thanks for the info. I am one that is glad that my cardiologist years ago told me to be sure and take antibiotics before any dental work and I will continue to do so.
Take Care

 

[Harpoon]

Yeah, before anyone tosses their bottle of amoxicillin out the window I think it would be best to wait for a good study on the subject.


Endocarditis is NOT a good thing to play with.

It's hard to do such a study. You need to look at patients that are taking antibiotics versus those that aren't. You need to look at how they're taking it, are they sticking to prescription orders. What kind of health are they in BEFORE the dental proceedure? After?

And for that matter, you also have to look at the dental office, sterilzation techniques, the procedures done, time involved....


It's really got to be a comprehensive study.

For what? What are the side-effects of taking prophylaxis before seeing your dentist? Are these side-effects serious enough to warrant such an involved study to confirm or dispute it's effectiveness as a means of preventing a life-threatening infection?

Dunno. I pay out of pocket for my amoxicillin. I also pay out of pocket to see my dentist. The pills aren't the most expensive in my medicine cabinet and they've never been a problem for me to take outside of choking them down (I have trouble swallowing big pills at times.)

I'd rather take something I don't need than not take it and end up with endocarditis. People often end up on transplant lists because of infections like that.

 

[Guest]

I don't necessarily believe in everything that I post, but I think everyone needs to be informed as to what studies are being done.

The neurosurgeon at our hospital is fond of saying that there is no evidence that the people whose fractured vertebrae he repairs do better than people who do not have their cracked vertebrae repaired. However, it does seem logical that fixing a cracked vertebrae so that it does not sever the spinal cord should result in a better outcome than letting people run around with cracked vertebrae. The trouble with doing a study on this is that it is so hard to recruit people for the placebo group (ie sham surgery so they think that they had a repair when they really didn't.)

 

[tobagotwo]

I find the post very intriguing, inthat it basically says that medicine is being prescribed, administered, and required, without any apparent study of efficacy being performed. Normally, the FDA requires such a study before doctors are allowed to prescribe a drug for a new indication.

We suppose it helps, but no one appears to have shown that it actually does.

My dentist won't work on me without the Amoxi, so it's moot in current terms. However, I think these dentists are correct to insist that a proper study be done to show efficacy. It is actually part of federal regulations. Personally, I would continue to take them until I found out that they have no value.

Thank you for posting it as an object of interest. I appreciate that you post things from reasonable sources regardless of whether you personally ascribe to the contents.

Bets wishes,

 

[Marty]

An anecdotal report. I've had MVP all my life and mitral valve replacement
1998 with mechanical St. Jude.I've been going to the same dentist over 30 years. He has never prescribed prophylactic antibiotics. Why? He was just out of Georgetown dental school in 1970 and said he had looked into the problem and found no evidence in favor of it. Well so far he's right. I have never gotten SBE. He has never had a case in his practise.

 

[Susan BAV]

Interesting... We used to be prescribed nine pills, I think it was, some of them an hour before the dental appointment and then the remainder to be taken four hours afterward, if I recall correctly. (...six before and three after or vice versa, something like that...) They switched to the four pill prescription a few or several years ago. I've taken them as prescribed for at least 25 years now and plan to continue.

 

[perimeno]

what dosage?

what dosage?

Just wondering what dosage everyone takes, (how many mg for how many days before/after? I do not have a heart problem (my brother had avr), but after reading about how some people who were otherwise healthy, ended up with a heart problem after dental procedures I wonder if I should be taking some just in case?
Peri

 

[Marty]

It doesn't matter what antibiotic you take as long as you are not allergic to it.
I've seen all kinds of dosages from one pill to twelve. I suspect that this is because a doubleblinded evidence based study has never been done. Many of our medical rituals continue in this manner. My poor wife took estrogen for thirty five years because her doctor said it would keep her forever young. Now a big study showed it not only doesn't keep you young, it causes breast cancer, dementia, heart problems, etc. Still seems to help the bones. Years ago at Mayos they did a study to see if it helped reduce infections to swipe the skin with an alcohol sponge before a needle stick. Results? No help. However nobody gets stuck without an alcohol swipe, do they? While I have never personally seen or been involved with a patient who developed SBE soon after dental procedures, I have seen anaphylactic reactions to both oral and injected penicillin. One young man had his reaction while in the dispensary minutes after an oral dose. He would have died at home. That's the main reason I personally was happy with my dentists position on prophylaxis.

 

[Granbonny]

Peri

Peri

After my valve surgery..my dentist wants me to take...4 Amoxxicillin 500 mg. 1 hour before my appointment. None afterwards...Marty..cannot remember the last time I swiped my finger with alcohol before testing my INR. Just wash under very hot water to get the blood flowing. 2 minutes and blood flows. bonnie

 

[perimeno]

Granbonny

Granbonny

Wow, that's a lot of amox all at once. I just finished taking some for a throat infection and I was taking 500 mg spread out 3 X a day. Anyway, thanks for the info. I have to see the dentist soon for a crack in my teeth and have been wondering about taking something.
Peri

 

[bvdr]

Peri,

The dose that Granbonny told you is the exact one I use. Amoxicillin 2,000mg one hour before dental procedures.

 

[Blanche]

It's always good to know what is being studied, even if one does not agree with the conclusions. Albert got bacterial endocarditis WHILE he was medicated. He had a slight mitral valve prolapse. At that time, at lease in my neck of the woods, alot of dentists and doctors didn't prescribe antibiotics for folks with prolapses. Albert was about 53 years old when he began taking antibiotics for dental work. Our dentist said that in his entire career he had never heard of anyone getting bacterial endocarditis from dental work. If he had been right, just think of all the fun we would have missed.....hospitalizations, continuous IV for 4 weeks, heart surgery, stroke, and so many emergency visist that I have lost count.

Currently Al receives IV antibiotics before dental work because of his special circumstances.

Regards,

Blanche

 

[Georgia]

When I started on antibiotics for dental procedures in 79 I was on them for 7 days. Which, considering that I was forever having something done (I'm the queen of root canals, in-lays, on-lays and crowns) meant that I contributed mightily to the well-being of drug firms!

 

[Abbanabba]

Lucky me - I'm off to the big city tomorrow for 3 days worth of dental work (..oh yippee!..). Got my script for amoxicillin today, which I only need to take an hour before each procedure. Considering things are a bit dicey at the moment, I'd rather not take the risk.

A : B

 

[epstns]

A : B,

I'm with you, only I don't tolerate penicillin derivatives very well. My dentist prescribes Clindamycin, 600 mg. the standard one hour before treatments. I just keep a bottle of them around (and watch the expiration dates. . . ) for that next visit. I also have dental cleanings 3 times a year now, just in case. I think I've gotten all caught up with the dental work so that whenever VR time is here I won't have to delay just for dental work.

 

[Marty]

Hey, its OK. If taking antibiotics makes us , and our dentists feel better, why not, if we are not allergic? However SBE is tricky. People do get it while on antibiotics as noted above. Also, a study a few years back showed that when we brush our gums showers of bacteria enter the blood stream. Most of the time our immune system and lymph nodes eat 'em up. Should we take amoxicillin before brushing our teeth?

 

[ALCapshaw2]

SNIP - a study a few years back showed that when we brush our gums. showers of bacteria enter the blood stream. Most of the time our immune system and lymph nodes eat 'em up. Should we take amoxicillin before brushing our teeth?

Good Question Marty !

I've often wondered about the BEST order for Brushing, Flossing, and Rinsing with Listerine since I sometimes bleed a little if I brush way too hard or pull too hard on the floss between tight teeth. Any ideas / recommendations?

'AL Capshaw'

 

[Granbonny]

I brush with a very soft bristle Reach toothbrush..and use Listerine Essential Care toothpaste. Kill 2 birds with one brushing I can brush very hard with no bleeding. 3 weeks ago I had a deep cleaning. The dentist and I were chatting..and I think she hit a nerve under my back gold crown. 2 weeks later. it started to hurt..especially riding in car with a/c blowing on my face. It would be fine and then bam..pain from no where. Went thru a bottle of Ambesole sp?..Finally quit after 2 weeks. I was wondering if I should have taken an Amox? but never did... Learned the next time to keep my mouth shut while she is deep cleaning. Bonnie