Routine tooth cleaning - Precautions

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carolinemc

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Correct. I can't take amoxicillin any more (had an allergic reaction about 10 years ago) so for dentist/cleaning I take - let's see if I can spell it right - azithromycin. I 4get the dosage off top of my head.

Oddly it was flagged by my dentist for warfarin interactions after I had already been taking it like 4-5 times as prescribed BY THE DENTIST and OKed as per my GP doctor, but the dentist said that he would not allow me to take it without a cardiologist signing off and that he would no longer fill the script. So I had to jump through more hoops on that....
I feel for you, but some dentists feel they are not to pre-medicated a heart patient. I have had some in the past that refused to just call the pharmacy and script the premedication. I used to as a child took Penicillin shots before a dental procedure, including cleanings, then kept the routine as an adult, for the dentist will not touch a heart patient without the pre-med. I have a new dentist and we are getting ready for three teeth pulling's and he is getting information on my Warfarin. We will know soon and hope to be done with the teeth soon. I too, can't take amoxicillin due to allergic reaction over 20 years ago at the dentist office. But can take other antibiotics. I am on clindamycin 150 mg. But will be feeling better once we got the dental stuff done. I hate teeth pulling. But eventually get a partial done. Not ready for full sets of dentures. LMAO!
 

pellicle

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Are you all sure that antibiotics are necessary before a routine dental cleaning? Dental cleanings are non invasive and very similar to normal daily dental hygiene
Well then, they are clearly not doing sub gingival plaque removal if your conjecture is correct.

Imagine a sharp steel thing going under your gums and scraping off the homes of all the bacteria in your mouth.

The bleeding? Well that just opens doors to the now free floating (no longer sessile) bacteria.

It's like smashing up a coral reef at a micro scale.

Me, I'll take 2g and not spin the endocarditis wheel.

Are you feeling lucky?
 

Unicusp

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Well then, they are clearly not doing sub gingival plaque removal if your conjecture is correct.

Imagine a sharp steel thing going under your gums and scraping off the homes of all the bacteria in your mouth.

The bleeding? Well that just opens doors to the now free floating (no longer sessile) bacteria.

It's like smashing up a coral reef at a micro scale.

Me, I'll take 2g and not spin the endocarditis wheel.

Are you feeling lucky?
Thanks for the information. Amazing how our many Doctors don't seem to be on the same page. Leaving research to the patients. But, I'm used to that now. Yes, I agree and am going to take preventive measures before my cleanings. Luckily I have not had one since surgery, but have one scheduled early next month. Thanks!
 

Unicusp

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Unicusp - yes, there is deep cleaning/scaling that is much more aggressive but mine was just my 2X year routine cleaning. Although instead of flossing my dental hygienist used a different procedure she had adopted which felt like sand blasting and stung my gums causing a little more bleeding than usual. She still works there but my dentist now keeps us apart! Anyway, about 10 days later I became very sick and a week after that I was delirious and sleeping most of the time. My wife took me to the ER and after being checked in it still took a week or two before I was properly diagnosed. Then it was emergency OHS the next morning. The surgeon said my mitral valve was shredded and he was surprised I had stayed alive all that time. I was very fit before the endocarditis, which he credited for my survival. So, I have had a mechanical mitral valve for 10 years this September and I am very pleased with both the valve and the level of fitness that I have been able to return to.
Ah yes, that may have been ultrasonic cleaning which seemed to be popular over 10 years ago. I recall having that style back then, but not since. I'm going to play it safe and take the 2g. Thanks again!
 

Critter

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It is a well known fact that common throat bacteria have been identified in cardiac tissue. To my knowledge valvular replacement is the only reason to get antibiotic prophylaxis. Ortho physicians want it done for artificial joints but there isn’t any evidence of that the benefits of protecting a joint outweigh the risk for potential medicine reaction.
 

AZ Don

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Are you all sure that antibiotics are necessary before a routine dental cleaning?
Yes, for those with prosthetic heart valves, according to the American Dental Association and the American Heart Association:

They used to recommend it for those with BAV, but sometime around the time that I was diagnosed (2013), they dropped BAV from the list.
 

Chuck C

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Unicusp - yes, there is deep cleaning/scaling that is much more aggressive but mine was just my 2X year routine cleaning. Although instead of flossing my dental hygienist used a different procedure she had adopted which felt like sand blasting and stung my gums causing a little more bleeding than usual. She still works there but my dentist now keeps us apart! Anyway, about 10 days later I became very sick and a week after that I was delirious and sleeping most of the time. My wife took me to the ER and after being checked in it still took a week or two before I was properly diagnosed. Then it was emergency OHS the next morning. The surgeon said my mitral valve was shredded and he was surprised I had stayed alive all that time. I was very fit before the endocarditis, which he credited for my survival. So, I have had a mechanical mitral valve for 10 years this September and I am very pleased with both the valve and the level of fitness that I have been able to return to.
Wow!

I have found that dental hygienists really vary.

When I was in my 20s I did not floss enough and when I would go in for a cleaning, my gums would bleed when the hygienist flossed me. At some point, around 30, I got real serious about dental care and started flossing daily, using a water pick daily, making sure that I used mouthwash with fluoride, ect. Since then my teeth have been great and not only no issues with bleeding with flossing, but the hygienist recently joked and said "Why are you here?" because when she did the scraping and such, there was literally nothing there to remove.

However, there are some hygienists out there who have no business in this line of work. My previous dentist had 2. One was professional and gentle as she scraped and flossed, the other one was so ham handed and abrasive that she always managed to cause bleeding. My whole family was aware of it, and when we'd go for an appointment, it was always a matter of hoping to get the good one.

I'm at a different dentist now, and although I have not had any bleeding issues since being there for the past 7 years, as a precaution my personal policy for the last 18 months is to not let them floss me. I floss daily, so why do I need the hygienist to floss me? I just don't want to take a chance that one of them might be a little careless and cause bleeding and cause unnecessary endocarditis risk.
 
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Warrick

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When you read some of the posts in this thread a dentist giving INR advice seems like a roading engineer doing a wheel alignment on a car...
 

dornole

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The American Heart Association guidelines changed for me too. When I was first diagnosed they said premed for cleaning. Now routine cleaning is no longer on the list. I still have my native, repaired valve.
 

tom in MO

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Are you all sure that antibiotics are necessary before a routine dental cleaning? Dental cleanings are non invasive and very similar to normal daily dental hygiene. The heart org endocarditis card that I received does not specify that antibiotics are required for cleanings.
I guess if one bleeds alot during normal flossing, then yes. My Cardiologist, PCP, and dentist all said not necessary for cleanings. Did anyone find this requirement documented in literature? Thanks.
Pre-op or biological valve, pre-dental antibiotics are not needed. They used to be for pre-op but it changed a few years ago. Mechanical valves need prophylactical antibiotics due to turbulence.
 

Superman

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It’s all risk related. My understanding is the change in guidelines came about has we began to learn that frequent use of antibiotics begat antibiotic resistant bacteria. So, with that information, let’s evaluate the risk / reward of situations where it used to be routine to prescribe antibiotics.

Others have pointed out the recent guideline changes, so no need to rehash. Those of us who have known of our condition for years are used to it, and not taking them is weird. With a more recent diagnosis, it may seem strange to have to take them.
 

Chuck C

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Are you all sure that antibiotics are necessary before a routine dental cleaning? Dental cleanings are non invasive and very similar to normal daily dental hygiene. The heart org endocarditis card that I received does not specify that antibiotics are required for cleanings.
I guess if one bleeds alot during normal flossing, then yes. My Cardiologist, PCP, and dentist all said not necessary for cleanings. Did anyone find this requirement documented in literature? Thanks.
Good question.

The current 2021 guidelines recommend antibiotics as a prophylactic prior to dental procedures for the groups listed in Table 3 of the 2021 statement from the AHA linked below:

Prevention of Viridans Group Streptococcal Infective Endocarditis A Scientific Statement From the American Heart Association


Please see Table 3- you will note the inclusion of:

"Presence of cardiac prosthetic valve"

I had my operation at UCLA and they consider a dental cleaning a dental procedure, and, as such, recommend 2,000mg of amoxicillin prior to a dental cleaning or any other dental procedure.

However, you will find in the conclusion of the publication the following:

"We cannot exclude the possibility that there may be an exceedingly small number of cases of VGS IE that could be prevented by AP for a dental procedure. However, if prophylaxis is effective, we believe that such therapy should be suggested only for those with the highest risk of adverse outcome from VGS IE, although we acknowledge that the effectiveness of such prophylaxis is unproven"

So, antibiotics are not yet proven to help prevent endocarditis during a dental procedure, but they are still recommended. Personally, given that I tolerate amoxicillin very well and the very low risk of side effects from one dose, I plan to always go with the recommendation during any dental cleaning or other procedure, as is the practice of Dr. Shemin's office at UCLA and also my dentist.
 

slipkid

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I 4got to say that b4 I even had OHS & got the mechanical valve I had a heart murmur (actually more than one leaky valve) for many years. Somehow (I can't remember how) that became known to my dentist and then he required that I take anitbiotic (was amoxicillin back then, prior to my having an allergic reaction to it after years of taking it for various things) prior to cleanings or oral surgeries. Then at some the guidelines did change and I was told it was NOT nec. to take the antibio anymore.

Then of course after OHS/AVR it became nec. again.
 

Chuck C

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I 4got to say that b4 I even had OHS & got the mechanical valve I had a heart murmur (actually more than one leaky valve) for many years. Somehow (I can't remember how) that became known to my dentist and then he required that I take anitbiotic (was amoxicillin back then, prior to my having an allergic reaction to it after years of taking it for various things) prior to cleanings or oral surgeries. Then at some the guidelines did change and I was told it was NOT nec. to take the antibio anymore.

Then of course after OHS/AVR it became nec. again.
Prior to 2007 it was standard medical practice for all with bicuspid valve and many other conditions to be given antibiotics. At the time of the 2007 guidelines a review of the evidence was done and it was concluded that all of the antibiotics being prescribed may be doing more harm than good, for things for which there was no evidence that it was doing any good. In fact, I believe that there was evidence that for certain patients it did no good at all. At that time the list was shortened significantly for those who would get antibiotics prior to a dental procedure. As those with prosthetic valves, we are on the list still.

When I had BAV, but before my AVS, I was twice given antibiotics prior to a cleaning. One time was due to the incompetence and a miscommunication of the assistant to my local cardiologist. The other time was just prior to surgery when I was getting a dental cleaning at the same time that I had my dentist sign off on my "dental clearance" needed prior to surgery. The form that he was to sign off on was printed 15+ years ago and still had the old pre 2007 guidelines. My dentist said that if he signed the form he would need to give me amoxicillin before the cleaning, because, even though he was aware it was no longer part of the guidelines, he was signing a document that said that he was supposed to give me antibiotics prior to cleanings as a BAV patient. Not that big of a deal to be given two doses of amoxicillin, but I would imagine that there are a lot of dentists who are not up on the guidelines still giving antibiotics to BAV patients, as it was the practice for so many years.
 

brijeshb

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Thank you all for all your valuable responses. It was very informative.

Just to be clear on the point in my original post " he said just skip one dose prior to appointment " . I take my warfarin at 7:00 PM daily and my dental cleaning appointment is at 9:00 PM. So the dentist suggested to push that days dose to take it post cleaning procedure. So there is no dose "skip" . Its only a delay by about 2.5 hours. I checked my INR this morning and its at 2.1. So I guess that should be fine..

Once again thanks for all responses.
 

pellicle

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I checked my INR this morning and its at 2.1. So I guess that should be fine..
remember that the INR is not a hard line that crossing means you instantly have a blood clot, stroke and die.

Indeed its like looking at your phone while driving, probably won't cause an accident, it depends on many things.

a recent post here:
 
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