Dental work and antibiotics, again

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Nupur

Well-known member
Joined
Sep 13, 2008
Messages
411
Location
SF Bay Area, CA
I know this has been discussed at great length here already. Sorry to bother everyone with this question again. I have a root canal coming up. Cardio said AHA guidelines have changed, no need for meds. Last week, during my surgeon consult, he (the surgeon) said, it is important to take meds for dental work, that he would hate to repair the valve due to endocarditis sooner than he needs to. I called back cardio and repeated this. Her nurse called back to say "no she thinks you don't need it". But well. I do! I want it! Who can I ask to prescribe antibiotics for me? Maybe the dentist himself? What should I ask for?

Thanks all, as always.
 
My dentist always prescribes my antibiotics for me and usually gives me at least 3 refills on the script so just in case I ever have a dental emergency, I'll have them on hand.

My cardio (who is very old school) calls the new guidelines the "great heart experiment". He told me that, like it or not, I was going to be part of the experiment. He obviously is very much in favor of taking antibiotics and even before my surgery, I always took them and would still.

Good luck with that root canal...I'd almost rather have heart surgery!
 
The dentist can get you a prescription, or you can talk to your family doctor. Just tell them your condition -- they deal with this all the time. I just call my PCP for refills prior to each visit now. BTW, I've had two root canals and neither was practically painful. I would go to an endodontist. The last one I had was done by an endodontist and he did the whole thing in less than 15 mins and was completely painless. It was actually easier than get a filling. Of course the costs for him plus the crown really made my wallet hurt, after I had exceeded my yearly max coverage that year.
 
I have always pre-med for any dental work. My dentist will call the Rx for amoxicillin & he too will usually prescribe extra pills for follow-up appt or emergencies. I would never consider going to a dental appt without any pre-meds. It used to be that I had to take like 5 amoxicillin pills an hour or so before the appt & then an additional 4 after the procedure. That's not the protocol any longer & I only take 4 pills an hour before the appt & that's it.

Good luck w/your root canal!
 
Nupur;
ask your surgeon or your dentist for a Rx for amoxicillin of 500mg. each

As directed by my dentist "take 4 tablets 1 hour before appointment"

If I were you, I rather be safe than sorry so do try to get an prescription.
 
Freddie said:
Nupur;
ask your surgeon or your dentist for a Rx for amoxicillin of 500mg. each

As directed by my dentist "take 4 tablets 1 hour before appointment"

If I were you, I rather be safe than sorry so do try to get an prescription.
Click to expand...


Hi Nupur,

Your surgeon is so correct! I echo Freddi'es words.

Who is doing your root canal? Not to discourage you, but I had a bad experience many years ago when my dentist tried to do mine and it took several weeks due to returning infection which was resolved after one visit to the endodontist.

Good luck :)
 
Presumably due to me having been referred to our hospital dental department as 'high risk' our local cardiologist gave a talk to the the dentists here about endocarditis. It is his view that although the guidelines had changed any cardiac patient who expressed a wish to have antibiotic cover should be given it. In his words, "endocarditis is not nice and anyone who has had it will say they don't want it again". My dental surgeon is happy with that, he wasn't happy at being told NOT to prescribe them.
 
My husbands PCP writes him a script for Amoxicillion at his annual visit every year when he writes his other prescriptions. He said he thinks he should always have them on hand,
 
i have had 2 crowns and an extraction done without antibiotics all was ok but really tried to get dentist to listen but he was just repeating there is more risk from brushing your teeth and the guidelines have changed and he wont prescribe me antibiotics which really pees me off .i need a deep filling and injections to mend a broken filling ASAP and would really like the antibiotic cover especailly as i am waiting surgery!
i am at a loss because damage that can be done surely they should air on the side of caution and give the antibiotic cover!
 
My dentist said they will always want me to take the antibiotics before they do anything. THey said some heart doctors are saying you don't have to but my dentist disagrees. Actually they said cleaning the teeth is very dangerous because they are stirring up bacteria. THey gave me the 4 500mg amoxicillian 1 hour before procedure and they gave me a dose to keep on hand in case I needed some emergency dental work..... I would call your dentist.. Hope all goes well.
 
My surgeon, PCP, cardio and dentist (and I) all agree I should never have any dental work without pre-medicating. My cardio prescribes them but I am sure my dentist would if he did not.
 
The great heart experiment is what got me here..Hearing about the change in thinking, I asked at my physical for a note for my dentist saying I didn't need the antibiotics anymore. She wrote the RX then read my chart and said" You haven't had an echo for 5 years we should get one." I had the echo and was told to see a Cardio. The rest is history.
 
My dentist always has me dose with amoxicillin. This is true even if I am only getting them cleaned. As far as I know they raised the dose several years ago. I have not heard of any changes since.
 
deano89 said:
i have had 2 crowns and an extraction done without antibiotics all was ok but really tried to get dentist to listen but he was just repeating there is more risk from brushing your teeth and the guidelines have changed and he wont prescribe me antibiotics which really pees me off .i need a deep filling and injections to mend a broken filling ASAP and would really like the antibiotic cover especailly as i am waiting surgery!
i am at a loss because damage that can be done surely they should air on the side of caution and give the antibiotic cover!
Click to expand...

All I can say to this is that you are exposing yourself to tremendous risk without pre-meds for any dental work! I would demand that the dentist, cardio, PCP, give me an Rx for them. There are a lot of other dentists around but there's only one of you!
 
http://www.americanheart.org/presenter.jhtml?identifier=3047083



The new guidelines show taking preventive antibiotics is not necessary for most people and, in fact, might create more harm than good. Unnecessary use of antibiotics could cause allergic reactions and dangerous antibiotic resistance.

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.

Patients at the greatest danger of bad outcomes from IE and for whom preventive antibiotics are worth the risks include those with:

artificial heart valves
a history of having had IE
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 interventions, 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 prosthetic device
a cardiac transplant which develops a problem in a heart valve.
Click to expand...
http://www.americanheart.org/presenter.jhtml?identifier=3047051

I think that doctors are beginning to realize the societal harm that is occurring due to overuse of antibiotics. For instance, my husband has severe chronic sinusitis, and goes to a top ENT. He refuses to give him any antibiotics unless a culture of the material in his nose shows that he is carrying a certain strain of bacteria, and then he gives him a drug especially for that bacteria.

The days of a doctor giving antibiotics to all comers has passed. There are serious, deadly resistant strains of bacteria that have emerged due to the overuse of antibiotics in the past.
 
Last edited:
Thanks for your responses everyone. Like Dean, I was ok without anti-biotics for dental work according to the new guidelines. I thought now that I am aware of endocarditis, I will watch out for it after dental work and go to the doctor at the first sign of anything. But after the surgeon spoke to me last week, I am conflicted. Just made a call to PCP to ask for meds, with an additional comment on the message that says "patient is aware of change in AHA guidelines, but still wants to be premedicated".

Braveheart, I see your point too. In general I am very anti drug, and don't take any unless absolutely necessary. The prospect of endocardititis is very scary though.
 
the trouble i see is endocarditis has very vague symptoms to start with and does a lot of damage if it gets a hold so i like you Nupur since knowing my valve is no longer a standard MVP would like the safety net of antibiotics, but my dentist is adamant he will not give them to me . i am speaking to another dentist tomorrow to get her views on it .

thanks Sue just spotted the link will have a read now!
 
I just got my PCP to send a prescription to the pharmacy. She agreed to it, thankfully.
Dean, I hope you find someone who will prescribe them to you.

Now, the scary thing is that people who have had endocardits say that they don't know what caused it, and wasn't from a dental work. Who knows, even with all this precaution, infection might happen anyway. But better safe than sorry.
 
So I thought that I might add my opinion even though it will be about the same as others here. I think they have lowered the use of antibiotics for dental work according to the AHA. However, if you have an artificial valve or have had endocarditis in the past, you should still get them. I recently got endocarditis and probably got it from brushing my teeth. Therefore the doctor is probably right. Yet as someone who has just gotten done with a treatment for endocarditis, now have A-Fib (didn't have this before), and may need surgery for damage to the valve associated with the endocarditis, I would take the antibiotics. The threat of all this is not worth it.
 
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