Very Sad

[pellicle]

I read this today and reading between the lines I see so many errors which just should not have happened

http://www.abc.net.au/news/2015-01-12/wa-woman-dies-after-two-teeth-removed/6012858

 

[epstns]

You had me fooled - for a moment I thought this was from a US news source. Our national news services have become so sensationalist that even a hangnail can be the number one story on the evening news. I see what you mean about all the mis-information - for example, where was the proof that a dental procedure caused the patient's need for a prosthetic valve? Not a normal occurrence. Usually some other cause, but may have happened after dental work if she developed endocarditis due to a compromised aortic valve at time of dental work. Patient might not have known about something like aortic stenosis, but sans preventive antibiotics, she could have developed endocarditis following the procedure.

Also, how was the gastro-intestinal bleed caused by dental work? Sounds more like poorly managed ACT.

Either way, a sad outcome that was really preventable.

 

[katielady72]

I am having some dental work done in March, long story short I am having 5 teeth extracted to make way for a denture. This story has made me very nervous. I was told by my surgeon and cardio to just remember to have antibiotics before/after the procedure. My anti-coag specialist is aware of my situation and said she would discuss things with my dentist. Should I be nervous? At the time of my appt. I will be 8 months out after my AVR with a St. Jude mechanical. Thanks in advance

 

[Paleowoman]

Tuesday a week and a half ago I had to have some emergency dental work, followed last Monday by root canal treatment. Both dentists refused to give prophylactic antibiotics as the UK NICE (National Institute of Clinical Excellence) "guidance" says not to do this EVEN though NICE are now reviewing their guidance due to the increase in number of cases of infective endocarditis since their original guidance in 2008: https://www.nice.org.uk/guidance/CG64 Note it was GUIDANCE only. No dentist or doctor has to obey NICE guidance.

To be fair, the first dentist gave me a seven day course of amoxicillin at 500mg three times a day - after he'd done his work - to hopefully clear up the infected tooth, and the second dentist said I would be alright to do root canal treatment without more amoxicillin. Well I don't know. I don't feel wonderfully secure knowing that I had, or even still have, a dental infection, with root canal treatment AND that I currently also have a sinus problem.

I now have a letter from my cardiac surgeon saying that I should have prophylactic antibiotics and my GP has given me 2g amoxicillin to take when I have the next dental appointment next week for the next stage of the root canal treatment.

I never had to have any dental work done for the past 14 years ! My teeth have been really fine. This problem is due to a "cracked" tooth….terrible timing now that I've had AVR.

 

[cldlhd]

They're worried about antibiotic resistant bacteria but personally I'd rather have them . My dentist says they're not going to be necessary for me if my BAV is repaired but my GP says he'll give 2g before dental work if I want.

 

[Paleowoman]

They're worried about antibiotic resistant bacteria.

I know, but why they think that we should risk our health and perhaps lives (IE carries 50% mortality) just to stop antibiotic resistant bacteria I don't know BECAUSE antibiotic resistant bacteria are coming mainly from factory farmed cattle and other animals fed antibiotics all their lives ! And from people who live in countries where they can buy antibiotics without prescription and take them unnecessarily ! And from people who get prescribed antibiotics and then don't finish the course ! This is all about protecting the 'herd' - the herd of us humans. I always take antibiotics responsibly, as well as hardly ever, and I don't eat factory farmed meat either. So I'm already doing my bit to help the herd and prevent antibiotic resistant bacteria !

 

[cldlhd]

I know, but why they think that we should risk our health and perhaps lives (IE carries 50% mortality) just to stop antibiotic resistant bacteria I don't know BECAUSE antibiotic resistant bacteria are coming mainly from factory farmed cattle and other animals fed antibiotics all their lives ! And from people who live in countries where they can buy antibiotics without prescription and take them unnecessarily ! And from people who get prescribed antibiotics and then don't finish the course ! This is all about protecting the 'herd' - the herd of us humans. I always take antibiotics responsibly, as well as hardly ever, and I don't eat factory farmed meat either. So I'm already doing my bit to help the herd and prevent antibiotic resistant bacteria !

I agree ,asking someone to put their heart at risk for the big picture is ridiculous, especially when they pump them into farm animals to make them fatter.

 

[pellicle]

Hi

I am having some dental work done in March, long story short I am having 5 teeth extracted to make way for a denture. This story has made me very nervous.... Should I be nervous? ... Thanks in advance

no, I don't think you should be nervous ... I think you should be aware, and you should be informed, but not nervous.

Many here have reported extractions on warfarin with few problems. I understood that if bleeding persists that Vitamin K can be taken to briefly establish clotting and if making no change to your warfarin intake will drop your INR briefly and it will return to "normal" levels quickly enough as the warfarin does its job in removing it again.

There were several points in that (sad) article which are good to learn from. Primary being you need to be your own advocate. Every instance I've seen of mistakes happening seems to have boiled down to a lack of oversight and a lack of responsibility.

My view is that no one is as invested in my health as me, I recommend that stance to everyone here.

Reading the article it is unclear if proper steps were even taken in even considering anticoagulation, but that could just be that the press are morons ... then there is the issue that :

It also found there to be no sutures and no gauze packing at the site of the teeth that had been removed, although there was "the appearance of blood clots consistent with extensive bleeding".

and that the finding is just plain "stupid" I mean really:

"acute gastrointestinal haemorrhage secondary to bilateral dental extraction, together with valvular heart disease".

my underline above, but it demonstrates that the problem which is likely the major one perhaps had nothing to do with the extraction to me the issue is acute gastro bleed and the dental extraction was secondary.

To me there is something else not mentioned here.

So, in short unless you have some other serious problems (like Celiac disease) you should be fine

(hate dentist treatments myself ... )

 

[pellicle]

Hi Anne

personally I think you should have the antibiotic cover until your tooth clears up ... the sinus thing is less important as I see it. Dental stuff goes straight to fast moving blood.

Tuesday a week and a half ago I had to have some emergency dental work, followed last Monday by root canal treatment.

Both dentists refused to give prophylactic antibiotics as the UK NICE (National Institute of Clinical Excellence) "guidance" says not to do this EVEN though NICE are now reviewing their guidance due to the increase in number of cases of infective endocarditis since their original guidance in 2008: https://www.nice.org.uk/guidance/CG64 Note it was GUIDANCE only. No dentist or doctor has to obey NICE guidance.

I would challenge them on this and put your foot down. Raise the "endocartitus" spectre (which is real enough).

I was going to post two days ago after an infuriating meeting with Dr Dork (MD) who completey had zero idea on the entire basics on the issues surrounding antibiotics. I shut his mouth (wisely) when I mentioned that I had a microbiology degree and it was clear that his points were self contradicting.

to the point; the issue with antibiotics is not caused by you or I being on them for longer term. Its caused by people with communicable diseases (and MSR is communicable) who irregularly take their antibiotics and leave a remanant population which are (by dint of remaining) those which are resistant. Infecting someone else with that (say, as happens in hospitals) is then the start of the chain in producing a resistant strain.

<offSoapBox/>

PS: I see this point in the link to NICE

Following the publication of new research at the AHA meeting in Chicago on 18 November 2014 showing an increase in the incidence of infective endocarditis in the UK, NICE has launched an immediate review of CG64 on Prophylaxis for Infective Endocarditis.

dolts

 

[Paleowoman]

Hi Anne

personally I think you should have the antibiotic cover until your tooth clears up ... the sinus thing is less important as I see it.

I think so too, but I can't get it. My tooth may have cleared up, but it's very confusing becasue I have sinus congestion/pain all that same side of my face which causes problems along jaw, in cheek, near my ear and under my eye, and I have jaw pain residual from keeping mouth open for 45 minutes when having the root canal done.

NICE are real dolts yes. And any medical professionals who follow their advice are dolts too&#133;sadly most :-( A previous GP pf mine said that NICE stood for National Institute for Cost Effectiveness - he would never have followed their guidance if he didn't feel it was right for his patient. It's a shame he left my GP practice :-(

 

[Eva]

In my case, I was advised to delay any major dental work for year after surgery. But that was an advice for me!

 

[tom in MO]

What I do not understand, is how one can floss regularly w/o antibiotics but antibiotic therapy is recommended for office dental procedures in the US? Flossing always results in a little bit of blood. Use of toothpicks should also be contraindicated if the scenario of oral bacteria causing endocarditis is correct.

It is true that endocarditis bacteria is often bacteria that is found in the mouth, but that does not mean it came from the dental procedure. There are other routes of causation than a dental procedure. For example, I had a friend who lost a lung to oral bacteria that was aspirated into his lungs. A dental procedure was not involved. The infection could not be cured w/o lung removal.

There is more and more information that points to a mass killing of your intestinal flora and fauna is not healthy. I know for me, my INR drops like a stone due to intestinal disruption. It seems to have been worse the last two times. Is the risk of stroke due to an INR fluctuation higher than the risk of endocarditis? I will bet nobody knows.

I am glad I home test every time I have to take those 2g of antibiotics. I have toyed with pushing my teeth cleanings to every 9 months just to avoid the two weeks of irritable colon the prophylactic therapy can produce. When I was a kid before dental insurance and dentists were not as common, they recommended 12 month cleanings.

 

[AZ Don]

What I do not understand, is how one can floss regularly w/o antibiotics but antibiotic therapy is recommended for office dental procedures in the US? Flossing always results in a little bit of blood. Use of toothpicks should also be contraindicated if the scenario of oral bacteria causing endocarditis is correct.

This is part of the logic behind the decision to scale back the administration of antibiotics - the risk from a dental procedure is not so different than that from flossing. Reading the above reference to CG64 and finding and reading the document, it seems that they identify people with valve issues as at risk for infective endocarditis, but do not recommend prophylaxis antibiotics for dental procedures. Seems to me they may have overshot the mark. In the US antibiotics are still recommended in some cases, see: http://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis.

This is an area of interest for me as I not only have a BAV as well as an aortic graft, but my step father died of an antibiotic resistant infection. Very scary stuff, he went from working in the yard to dead in two days. Antibiotics can kill good bacteria as well as bad, and in some cases the good bacteria is keeping the bad bacteria in check, so if the antibiotic happens to kill off the good bacteria and not the bad, then the bad bacteria can flourish. I doubt this is very likely to happen with a common drug like amoxycillin but I have read about this scenario occurring with more exotic antibiotics. My step father had recently taken a new antibiotic for a mild infection, and had not recently been to a hospital where he could have been exposed to an antibiotic resistant infection.

So not taking unnecessary antibiotics is not always just about helping the overall population, it can effect your flora as well. That said, infective endocarditis is very scary stuff as well and I wouldn't call antibiotics for dental procedures unnecessary. The US guidelines call for antibiotic prophylaxis for those with a prosthetic heart valve as well as some other situations (see link above).

 

[Paleowoman]

Flossing results in a little bit of blood ?!?!? I floss every day several times and I NEVER get any blood.

It's if the gums are inflamed or a person has peridontal disease that flossing can cause a bit of blood, but that indicates that the person needs a better clean and scale from the dentist to start with and then floss frequently - also no sugars or foods that encourage bacteria to stick to the teeth and gums which iritate them and lead to bleeding when flossing.

 

[cldlhd]

Rarely I'll get a swollen gum on the inside of my mouth and even more rarely I'll get too aggressive with the floss and get a small amount of bleeding. My teeth are definitely clean, just got my dental clearance for surgery and a cleaning while there. They said my teeth needed very little cleaning. I didn't see any blood when I rinsed after the cleaning. Not sure if that's down to a different hygienist, my teeth being clean or maybe they took it easy on me after hearing about my impending surgery...

 

[Paleowoman]

My gums don't bleed either when I have a clean at the dentist. They used to bleed in the days before I flossed regularly and before I used an electric toothbrush, and when I ate a diet more inflammatory to gums. My dentist now basically only does the clean to get rid of stains like tea and coffee. My current problems are due to a cracked tooth - maybe it cracked during OHS with all the equipment in my mouth - the ventilator and the transoesophageal echocardiogram and whatever else all at the same time - I have a small jaw and mouth. Or maybe it cracked on a nut I ate. Who knows…….

 

[cldlhd]

I have a cracked tooth also. I use a philips sonicare and I floss twice a day . I think the previous hygenist learned the trade watching the movie "The Marathon Man"....

 

[pellicle]

Just generally speaking, my dentist(s, plural because more than one have said this) have said that bleeding from the gums when flossing is an indicator of gum diisease (usually caused by plaque buildup). If you are experiencing bleeding from the gums when flossing (and you aren't just jamming the stuff hard and ham-fistedly into your gums) then you should consider seeing a dentist to check for sub-gingival plaque buildup

if you were to compare the small amount of bleeding that may arise from flossing to a full dental clean (subgingival) its so stunningly different you may be shocked. Ask to observe (if permitted) or set up your phone to video it. Normally you don't notice because someone is in there sucking it out fast.

Then there is the massive amount of bacteria liberated when breaking up the plaque ... in much much larger amounts than even possible with flossing (which should only be removing food).

 

[cldlhd]

I have to admit during my invincible years I skipped the dentist along with all doctors for years. I was born with straight teeth and never had any real problems,but I have seen the error of my ways. My last cleaning they said there was virtually no plaque so I must be doing something right.