Dental clean after Valve Replacement

[pellicle]

sorry pellicle but to make a sweeping statement about the uk and how they keep valve patients in the dark etc is way off, do you live here?

I believe you will find that those words were a resident of the UK, and if you are going to say I'm way off base can you provide something to support that?

The issue of antibiotic policy has been discussed here ... so I'm sorry you don't like your govenment policies, but Paleogirl has also mentioned annoyance with the UK penchant of not even allowing antibotics as a just in case due to farcical issue of it being a contributor to the long term viability of antibiotics. This is something which I do know something about.

yes there are professional and experts which am sorry you are not,no offence mate

none taken ... and I note that you too are not expert either. I think however that I may just have more knowledge and education on things microbiology than you do, certainly more than you credit me for, but I wouldn't know. Face it, you know stuff all about us and you wouldn't know who here was qualified in what. I've already mentioned that my degree was in microbiology in the past many times. Not that it matters.

Obviously I've tweaked your very Brittish honor bone. When I used the term "holes" I was using a double meaning for:
* strictly focused on their own silo of professional work not taking a more wide view or holistic approach (a common modern criticism being addressed at university now)
* as well as their heads in places where they don't see the bigger picture ... your inference of arse may be correct however.

Myself, I hope you don't get endo and I hope that you take antibiotics before a dental hygine clean.

PS: I note your compassion to Tims (a member here) issue in your post too. A member here nearly dies from Endo and your first thought is to hoe into me about critical words of the UK policy on antibiotics ... man you've got your prioritys differently aligned to me.



PPS, some policy stuff on the UK (not just blanket statements, hard facts)

https://www.dentalprotection.org/uk/...ic-prophylaxis

Background to the existing NICE guidance

For many years it was accepted clinical practice, when carrying out dental procedures on patients who were considered to be at risk of developing IE, to administer preventive (prophylactic) antibiotics beforehand. The evidence base for doing this, however, was not clear.
The guidance produced by NICE in 2008 was based upon the best available published evidence at that time and a consensus of multidisciplinary, expert opinion. The evidence demonstrated that there is no consistent association between a patient having an “interventional procedure” (dental or non-dental) and the development of IE. On this basis, the clinical effectiveness of antibiotic prophylaxis is not proven. The evidence also suggests that antibiotic prophylaxis against IE for dental procedures is not cost-effective.

so its not cost effective .... but is it effective?

http://www.nature.com/bdj/journal/v2...j.2016.49.html

Infective endocarditis is a devastating disease with high morbidity and mortality. The link to oral bacteria has been known for many decades and has caused ongoing concern for dentists, patients and cardiologists. Since 2008, the UK has been out of step with the rest of the world where antibiotic prophylaxis is recommended for high-risk patients undergoing invasive dental procedures. Recent evidence that identified an increase in endocarditis incidence prompted a guideline review by NICE and the European Society for Cardiology – which produces guidance for the whole of Europe. Despite reviewing the same evidence they reached completely opposing conclusions.

but that's just words isn't it Neil ... just just stats, just fluff ... emotional reactions to your national pride are more in step with whats needed right mate? Too difficult for you to grasp that medical professionals may disagree strongly with the European Society for Cardiology opposing the NICE guidance.

did you even go to University? What did you study?

 

[pellicle]

one more bit from that above journal

http://www.nature.com/bdj/journal/v2...j.2016.49.html

So what should UK dentists do?

As was pointed out in a recent letter to the BDJ on this issue, guidance is just that – guidance.[SUP]15[/SUP] It is not mandatory, although at times it may seem like it, mainly because clinicians feel the need to justify any deviation from that guidance, not least for fear of the legal consequences.[SUP]16, [/SUP][SUP]17[/SUP] Clinical guidelines, however, are not applicable to every patient and every situation and even the NICE guidelines point this out: 'Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstance of each patient, in consultation with the patient and/or their guardian or carer.'
In the current climate, informed patient care is paramount. Although this requires a knowledge of the best evidence and advice, it also requires an understanding of individual patients' expectations, concerns and values so that a dialogue can occur between patient and clinician to enable an informed and individualised choice

underline mine

Tims point of no mention in the dentists and no discussoin does not constitute "informed patient care" ... not where I come from anyway. Perhaps in the UK ... of course I'm no expert on that either.

 

[Agian]

most peoples teeth bleed on brushing a bit anyway

They shouldn't. Brush and floss twice a day.
Is taking a one-off antibiotic such a big deal, for piece of mind?
'... a consensus of multidisciplinary, expert opinion.' The NICE tossers actually used the word CONSENSUS, when there is none.

 

[rakesh1167]

Several Doctors asked if I had had any dental treatment…. Yes, the morning of the hospital admission…10 am scale and polish at Dentist, 10pm raging 40 degree fever and blue-light to hospital.. They ALL said that was the most likely culprit. I asked how to avoid and the reply was ‘don’t go to the dentist…it’s your choice, heart or teeth…’. Seems human oral bacteria is a particularly nasty cocktail of bugs that doesn’t really want to be allowed in your bloodstream. Plenty on the www about it, nothing in the dentists waiting room...

Did they mean don't go to dentist within a specific time window? It has been 6 months since my surgery, i am thinking of waiting for couple of months more before going to dentist( i will take antibiotics for sure).
How often should people with artificial valves go to dentist? It seems to be the trigger of endocarditis in many cases. Is it even worth it (going to dentist every 6 months)?

 

[pellicle]

Hi Rakesh

Did they mean don't go to dentist within a specific time window?

I don't know what they meant, I'm just quoting from Tim's email ... he was there.

It has been 6 months since my surgery, i am thinking of waiting for couple of months more before going to dentist( i will take antibiotics for sure).

I'd understood that 6 months was a good period of time to allow epithelisation of the valve stiching ring and stuff ...

when taking antibiotics one of the key issues is what I call "non thinking behaviour" ... so, as I understand it, the primary clinical issue that NICE seem to have against Antibiotics is when the person has an allergy to penicillin derived products. So before just blindly taking what the dentist gives you a script for firstly determine if you have a problem with antibiotics.

How often should people with artificial valves go to dentist?

as often as everyone else in my view

It seems to be the trigger of endocarditis in many cases. Is it even worth it (going to dentist every 6 months)?

I'm not sure I can see that ... what I see is that if you don't have antibiotic cover in increases your risks. I'm not sure if there are any recorded cases of people with prosthetic valves who took antibiotic cover that got endo ...

Personally I won't go to have a scale and clean without it ... I think its terrible that Tim wasn't made aware of it and thus didn't have the chance to make a choice. It would seem also that he was simply not even informed of it at all. Tims OHS was in July if I recall corectly

 

[Agian]

I think its terrible that Tim wasn't made aware of it and thus didn't have the chance to make a choice. It would seem also that he was simply not even informed of it at all. Tims OHS was in July if I recall corectly

You mean July, as in this year? So his endo was pretty recent then.
I'm grateful for this thread. Knowledge is power.

 

[pellicle]

You mean July, as in this year? So his endo was pretty recent then.

he got home yesterday, so yes, recent

 

[Agian]

he got home yesterday, so yes, recent

Is his valve all good?

The dentist must've known he'd just had OHS and SHOULD have known it was probably unsafe.
And no antibiotic cover! Well at least they've got the consensus NICE Guidelines to cover their arses.

NICE sounds like one of those tax-payer funded wank fests. I bet it comes complete with a suite of petty bureaucrats :-(

 

[neil]

cricky stats stats stats, your very good at them pellicle that there is no doubt, I like stats there are good to a point, but I prefer the experts I see face to face who deal with these things far more than any body on here, what am saying is the experts ive dealt with have been very good and this nice thing you keep going about is not used all the time its a recommendation which is ignored a lot where I come from,also my dentist doesn't take a lot of notice and I get anti bio on extractions etc, I cant believe people who think they know more than experts on the subject, am sure there are people all round the world who have been badly treated but in general we are so lucky to be treated and looked after by wonderfull cardio surgeons and nurses,yes I will blow the trumpet for the uk because they saved my life and look after me , why the hell wouldn't I, of course you can bring cases up of people being wrongly treated etc but you get that in any given field, an other thing don't try to be a smart arse telling me what uni I went to and how much national pride I shoud have , maybe am not as clever as you or have fancy letters in my name, but I have an opinion, thank you

 

[neil]

agian no taking a anti bio isn't a great deal, and when I have tooth extractions extrac etc I have them, but on a clean I don't, again my dentist is flexable in this matter, I personally don't see a problem in this, I have gum problems which unfort means I bleed sometimes when I brush my teeth not a lot and not all the time, in the uk we have different guidelines which ok some don't agree with but no system in the world has full agreement from everybody, I don't come on here and belittle the usa health system or any other because I don't live there and its not done imo, I make no apologies for sticking up for my health service and the help they have given me, am sure there are parts of other world health care which are better and worse, but I don't knock them,

 

[pellicle]

Hi Neil

cricky stats stats stats, your very good at them pellicle that there is no doubt, I like stats there are good to a point, but I prefer the experts

You do know the experts you trust read these same articles I posted right? Indeed experts YOUR trusted expert would respect wrote those articles.

Why don't you ask one of your trusted experts next time you see them, what would you say if they voiced the same opinion as me?

maybe am not as clever as you or have fancy letters in my name, but I have an opinion, thank you

So having a qualification only suits you when it's convenient. And by your degrading my degrees and my university studies to a bunch of letters after my name, perhaps you should apply that to the experts you trust too. Oh, but you're worshiping at their ivory tower right?

If one finds an area of your healthcare system that needs improvements and one dose not agitate for a change because of national pride then that's plainly stupid.

 

[pellicle]

agian no taking a anti bio isn't a great deal, and when I have tooth extractions extrac etc I have them, but on a clean I don't, again my dentist is flexable in this matter, I personally don't see a problem in this,

The problem is this : informed

You were and are informed Tim wasn't. I know you don't read replies but that's the primary problem under discussion.

Tim could have died, Tim is a UK citizen, but you don't give a toss.


The purpose of my post was to draw attention to the issue and perhaps save a life by creating an awareness that your beloved system does not provide.

If my post here saves one person in the UK from endo then that is good.

 

[neil]

ok ive put you on my blocked list as then I cant read your posts, maybe it would be better if you did the same that way no more pissing contests, even so I wish you all the best and its a pity its come to this, good luck

 

[Agian]

This is like a bloody soap opera.

 

[Agian]

 

[pellicle]

Neil

you bang on about you being entitled to your opinion, yet it was you who drew first here and took a shot about my opinion.

If you expect others to allow you to have an opinion, then try letting them have theirs.

If you do start an argument be prepared to provide some evidence to support it or be prepared to face the fact that your opinion may just be nothing more than your emotional reactions (which you are of course entitled to have).

It seems that my general lack of getting along with people is on those who have emotional views that do not fit the facts. I don't come here to socialise I come here to help people and advise and I know from the many posts here that I do that.

If I don't do it right for you well I'm sorry ... but so far you've not asked me for much, only challenged me.

 

[cldlhd]

Alright I'll get it out of the way - I'm not an expert and I'm not from the UK or Australia. I was told I had to wait 6 months post surgery to have a cleaning. I waited 10 months as my teeth are pretty clean and I figured a few extra months to be on the safe side. Even though the updated recommendations say I don't need antibiotics for a cleaning - I still have my BAV but it was repaired and my aneurysm was replaced with a graft- I take them anyway. My surgeon, who I consider an expert -he's currently President of the Society of Thoracic Surgeons here in the states-, wants me to take them before any dental work. I understand there are concerns about overuse of antibiotics but I'm not willing to do my part by dying or needing emergency surgery to prevent something that MAY happen some day.

 

[cldlhd]

[/QUOTE
Hey this can actually happen near where I live. About 5 miles from my house is Sesame Place- a kids theme/water park based on ,obviously, sesame street.

 

[Agian]

They use terms like 'guidelines' and 'recommendations' so that if things go wrong they can turn around and say 'it was ultimately up to the clinician'. It's a status symbol to these arseholes to get on these committees, because it means they're 'eminent' in their field. In this case, I don't think they'd have the balls to refrain from antibiotics, if their own welfare was on the line. Coward's work. There are people like that everywhere. For NICE to say it's a consensus is an outright lie, unless of course they meant it was a consensus amongst the people that formed the committee.

 

[Agian]

There was a guy at one of these charismatic churches who 'healed' people through the Holy Spirit. During one of his miracle working sessions, he got chest pain. He asked for an ambulance.