antibiotics before dental work

[Bina]

LILY....my dentist said the exact same thing, he would rather have me totally protected in case of a slipped tool or deep split in a tooth.
JKM7....I will also take those antibs until I drop dead from something else.

 

[Bear72]

I'll make this short and sweet. I also take clindamycin 2 hours before my dental cleanings and there is absolutely no way that I would stop. I only go to the dentist twice a year, and to be blunt, I don't want to be the one person out of 19,000 or whatever it is to contract endocarditis. After spending 5 months worried about my surgery, getting cut open and repaired, I'd like to stay out of the hospital for as long as possible.

My dentist wanted me to stop, but the Cleveland Clinic and my cardiologist say otherwise. Hence, the dentist followed their instructions and actually stated that he trusts their opinion a little more than the new guidelines.

 

[tobagotwo]

Woodbutcher, if you've been taking them before, there is no reason why you would suddenly go into anaphylactic shock from them now. Really odd reasoning from the dentist.

Best wishes,

 

[neil]

bob your post from 23 hours ago,in a nutshell thats what i was told,and i totally agree with it,never the less if you feel you need to take antibio tablets guess thats your call as well,

 

[Woodbutcher]

Bob H... I think the reasoning was that the more times you take it the greater the likelyhood of having an anophylactic shock ?

 

[Maryka]

Anaphylactic shock risk considered

Anaphylactic shock risk considered

When I became allergic to each of the 'cillin drugs I got a rash all over my body. Ditto for my daughter as she became allergic to the 'cillins. It is all a crap shoot, of course, but most people do not go into anapylactic shock the FIRST time they become alergic. I bet the odds of getting endocarditis from having no dental antibiotics is higher than having anaphylactic shock from an antibiotic you never previously got a rash from.

 

[neil]

yep it is a crap shoot,but the way i was told,the powers to be reckon youve more chance of trouble taking repeat doses of anti than not,again it all comes down to personnal choice,like most meds there are now finding if possible the less the better,

 

[tobagotwo]

Just to clarify...

The research of 50 years of premedication experience says the dental prophylactic antibiotics don't work. The chances of being struck by lightning are greater than the chances of the typical antibiotic premedication preventing infectious endocarditis. Comparing it with chances of anaphylactic shock is thus a fruitless endeavor.

As far as anaphylactic shock, I should have been more careful in my response, as those above have pointed out. The first reaction to antibiotics is rarely anaphylactic shock. Premeds are a one-shot deal, rather than a continuing regimen, so it reduces the likelihood further. The point is that the dentist or doctor would not have prescribed it again if you had any reaction previously.

Best wishes,

 

[jorsarge]

Hi all
It is 2 years since my valve replacement I did not go to a dentist until recently. My reasons were that I was scared and confused. Scared of endocarditus and confused because the whole dental preceedures confused me antibiotics/no antibiotics/bleeding/warfarin/time. Eventually I got round to actually going to the dentist. Even the dentist was not up on the facts so I discussed with him and off he went and got the facts for himself. I needed a root canal and 5 crowns which necessitated plenty of visits. On each visit I take an Antibiotic 1 hour before the proceedure begins.
The fact is that any of us that have valve damage/replaced need antibiotic cover. In any proceedurre where blood may flow and because of all the bacteria in out mouths it is necessary for us to have AB cover.

J

 

[neil]

jors its not a fact or else we would all take them, at the moment its a choice,although i will say it is a tough choice as there seems to be a split decision on this,as there say its a crap shoot

 

[Lily]

This may be one of those odd calls. "It's the very things that we think we know that keep us from learning what we should know?" I am a bit confused about it all.

I personally don't want flu shots, etc. And my opinion is generally similar to Neil's about meds, that, "...if possible, the less the better..." But I [live in the rurals and so] keep current with my tetanus shots. And meanwhile, I still want those antibiotics even though there may be honest research that questions the possible results. Maybe it's because I've seen antibiotics work for me, when I have a sinus infection or bronchitis, so I believe they can help me? I don't even want to think about the placebo effect .

My favorite solution is to stay out of the dentist's office . But that's not a good call either. My cardio told me that taking care of my teeth and gums was extremely important for my valve.

I am glad that we now only have four pills to take an hour before, rather than the tummy full before and after, as prescribed years ago.

 

[Adrienne]

Maybe it's because I've seen antibiotics work for me, when I have a sinus infection or bronchitis, so I believe they can help me?

It is exactly because they seem to work for infections that people already have that I question the new research and guidelines that say that premedicating doesn't do much. If antibiotics work so well to clear up something that is already there, why wouldn't they help to get to the bacteria before the bacteria even has a chance to circulate to the heart?

 

[neil]

lily yes i agree, like other things is a tough call,but new guidlines say you have more chance of problems taking anti than not,whether you choose to believe that is your personnal call,like i have said,i think we would all drather not have to make the call,anyways its snowing here so looks like building a snowman is on the cards yippppeeeeeeee

 

[tobagotwo]

From a post from 2007, here are the more specific (and restrictive) older guidelines from the AHA/ACC, endorsed by the ADA. The newer guidelines actually call for less use of prophylactic antibiotics, but are so vague and generalized that they lack substance in my view.

Not all dental procedures call for the use of prophylactic antibiotics. Some descriptions of when they would be used, if needed:

From the ADA website:

All patients in these high-risk categories may need antibiotics for all high-risk dental procedures. High-risk dental procedures are those involving bleeding or producing high levels of bacteria in your blood. They include:

all dental extractions
all periodontal procedures
dental implant placement or insertion of teeth that were knocked out
some root canal procedures
initial placement of orthodontic bands (not brackets)
certain specialized local anesthetic injections
regular dental cleanings (if bleeding is anticipated)

Another view of the guidelines of the American College of Cardiology, the American Heart Association, and the American Dental Association, in regard to when people using prophylactic antibiotics would use them for dental work (bolding mine)...

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 1 (operative and prosthodontic) with or without retraction cord 2
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


*Prophylaxis is recommended for patients with high- and moderate-risk cardiac conditions.

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

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

As even these more restrictive older guidelines describe "significant" bleeding as being the criterion, they are not referring to the occasional, accidental poke of a pointy probe.

Best wishes,