johnp
Well-known member
For those with valve (esp Mitral Valve) repairs/replacements -
What have you been told? Do you take meds before a visit to the dentist?
What have you been told? Do you take meds before a visit to the dentist?
Pre-Medication for Visits to Dentist ?
- Thread starter johnp
- Start date
Help Support Valve Replacement Forums:
I've had my aortic valve replaced, and both the cardio and surgeon emphasized that I should be pre-medicated (antibiotics, not "fun" stuff! 
) before dental procedures, including cleaning. I've been using clindamycin capsules (4 X 150 mg) with no real side effects.
) before dental procedures, including cleaning. I've been using clindamycin capsules (4 X 150 mg) with no real side effects.Jkm7
Well-known member
I have bovine mitral valve and my surgeon, cardio, primary care doctor and dentist all agree they want me to premedicate before every dental appointment no matter what I am having done. (I use 4 x 500 mg amoxycillian). I've had no side effects from doing this.
Same here. Premedicate before every dental appointment. 4 * 500 mg amoxycillian. No side effects.
I too take 4 105mg amoxycillian one hour before dental appointments.............my dentist stressed the importance ESP. before cleanings as they were removing plague that carries nasty bacteria ....the only side effect it seems is a bit of a system purge two days later
I have pre-medicated with 4 500mg amoxycillian before dental visits for cleaning, fillings, etc. for a long time. It used to be 4 tabs before visit and 2 tabs after the visit. No big deal and has had little effect on INR. I favor the anti-biotic use to kill any little critters the dentist might stir up.
ChicagoMammy
Well-known member
Ditto here
Trinityheart8891
Well-known member
same here, multiple cardiac defects including a VSD patch leak, as well as aortic regurg, and a funky mitral valve, no valve repair/replacement yet, (unless you consider the sub aortic stenosis resection with residual stenosis) but esp the patch leak mandates the antibiotics. . . 4 500 mg amoxicillin 1 hr prior is what I take
For anyone interested in perusing the newer guidelines for the prevention of BE from the American Heart Assocation (2007), here's the link: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.106.183095
I, too take 2 grams of amoxicillin 1 hour prior to dental procedures that warrant it.
I, too take 2 grams of amoxicillin 1 hour prior to dental procedures that warrant it.
JulieS
Well-known member
Same here qty 4 - 500mg Amoxicillin one hour prior
Natina13
Well-known member
I was also told by my surgeon/cardiologist, I will require antibiotic therapy before any dental work. I had actually always been given Penicillin pre-dental work, all my life, due to a heart murmur. As luck would have it, ( the dentist felt being intubated for my surgery may have loosened it) I had a cap come off a tooth that had previously had a root canal, 3 wks out from AVR/triple bypass. Unfortunately, the tooth needs pulled , then replaced with an implant, but my surgeon said no....not till at least 3 months post surgery and wait a little longer if no pain or infection.
Renee
Go Team 2011 !!!!
Renee
Go Team 2011 !!!!
Jkm7
Well-known member
My surgeon was insistent no dental visits for six months. Thankfully, everything in my mouth stayed quiet and I was okay with that. The longer you can wait to have the tooth pulled, probably the better.
johnp
Well-known member
Here's the poop. I used to pre-medicate, but based on my Cardiologist's recent read of the updated AHA guidelines, he says that AHA no longer suggests pre-medication.
Someone provided a link, thanks. I skimmed it and would conclude AHA no longer supports pre-medication.
What do you think? Is is still a good idea to pre-medicate when there is no clear evidence per AHA?
Summary
Although it has long been assumed that dental procedures
may cause IE in patients with underlying cardiac risk factors
and that antibiotic prophylaxis is effective, scientific proof is
lacking to support these assumptions. The collective published
evidence suggests that of the total number of cases of
IE that occur annually, it is likely that an exceedingly small
number are caused by bacteremia-producing dental procedures.
Accordingly, only an extremely small number of cases
of IE might be prevented by antibiotic prophylaxis even if it
were 100% effective. The vast majority of cases of IE caused
by oral microflora most likely result from random bacteremias
caused by routine daily activities, such as chewing food,
tooth brushing, flossing, use of toothpicks, use of water
irrigation devices, and other activities. The presence of dental
disease may increase the risk of bacteremia associated with
these routine activities. There should be a shift in emphasis
away from a focus on a dental procedure and antibiotic
prophylaxis toward a greater emphasis on improved access to
dental care and oral health in patients with underlying cardiac
conditions associated with the highest risk of adverse outcome
from IE and those conditions that predispose to the
acquisition of IE.
Someone provided a link, thanks. I skimmed it and would conclude AHA no longer supports pre-medication.
What do you think? Is is still a good idea to pre-medicate when there is no clear evidence per AHA?
Summary
Although it has long been assumed that dental procedures
may cause IE in patients with underlying cardiac risk factors
and that antibiotic prophylaxis is effective, scientific proof is
lacking to support these assumptions. The collective published
evidence suggests that of the total number of cases of
IE that occur annually, it is likely that an exceedingly small
number are caused by bacteremia-producing dental procedures.
Accordingly, only an extremely small number of cases
of IE might be prevented by antibiotic prophylaxis even if it
were 100% effective. The vast majority of cases of IE caused
by oral microflora most likely result from random bacteremias
caused by routine daily activities, such as chewing food,
tooth brushing, flossing, use of toothpicks, use of water
irrigation devices, and other activities. The presence of dental
disease may increase the risk of bacteremia associated with
these routine activities. There should be a shift in emphasis
away from a focus on a dental procedure and antibiotic
prophylaxis toward a greater emphasis on improved access to
dental care and oral health in patients with underlying cardiac
conditions associated with the highest risk of adverse outcome
from IE and those conditions that predispose to the
acquisition of IE.
Jkm7
Well-known member
I have a bovine mitral valve, fit in as one of the exceptions to AHA recommendationsa and there is no chance I will go to a dentist without premedication.
My dentist is still a proponent of using simple anti-biotics prior to invasive dental procedures...and I agree. It gives me a "warm and fuzzy feeling" to know that the inexpensive med can help prevent more serious health issues due to "germs stirred up by the dentist".
ChicagoMammy
Well-known member
Yep - my cardiologist said that although many people can stop taking prophylaxis I am not one of them. I guess it's the bovine valve.
John,
What this guideline emphasizes for me is the much needed discussion on the importance of fastidious dental hygiene (flossing, brushing, rinsing) on a daily basis which makes logical sense in keeping the bacterial load down in the mouth on a regular basis. As noted, the latest guidelines have have now reduced the need for antibiotic prophylaxis to only the population with "highest' risk of BE and who would have the worst outcomes. As shown below, this includes those of us who now have prosthetic heart valves. I personally don't believe there was enough emphasis in the past placed on the 'daily hygiene routine'.
Table 3
Cardiac Conditions Associated With the Highest Risk
of Adverse Outcome From Endocarditis for Which Prophylaxis
With Dental Procedures Is Reasonable:
Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
Previous IE
Congenital heart disease (CHD)*
Unrepaired cyanotic CHD, including palliative shunts and conduits
Completely repaired congenital heart defect with prosthetic material or
device, whether placed by surgery or by catheter intervention, during the
first 6 months after the procedure†
Repaired CHD with residual defects at the site or adjacent to the site of a
prosthetic patch or prosthetic device (which inhibit endothelialization)
Cardiac transplantation recipients who develop cardiac valvulopathy
*Except for the conditions listed above, antibiotic prophylaxis is no longer
recommended for any other form of CHD.
†Prophylaxis is reasonable because endothelialization of prosthetic material
occurs within 6 months after the procedure.
For Table 3: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.106.183095
Last edited:
Here's the AHA pdf of the wallet card that explains not only who should still premedicate and for what dental procedures, but the also dosages.
Justin meets a few of the requirements so always premedicates. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_307684.pdf
http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_307684.pdf
it also says
Changes in these guidelines do not change the fact that your cardiac
condition puts you at increased risk for developing endocarditis. If you
develop signs or symptoms of endocarditis—such as unexplained fever
—see your doctor right away. If blood cultures are necessary (to determine
if endocarditis is present), it is important for your doctor to obtain
these cultures and other relevant tests BEFORE antibiotics are started
Lyn,
Thanks for sharing the synopsis pdf for the guidelines. It is thorough, succinct and easy to print!
