Amoxicillin before a dental cleaning: tooth or consequences...

Johnpb · Dec 2, 2024

I'm supposed to go to the dentist tomorrow for a cleaning, my first visit since valve replacement, and I've been prescribed 4 x 500 mg tabs of amoxicillin to take an hour before my appointment.

I'm very nervous about the appointment. I've read that amoxicillin can pose risk of stroke and I have a history of stroke, so... In addition, the prescription docs note that the risks associated with preventive antibiotics in most patients - adverse reactions and development of drug resistant antibacteria - outweigh any benefits.

I don't even feel safe to take the amoxicillin at home and then drive to my appointment. I'm more inclined to go early to the appointment and take it there. Am I overthinking this???

d333gs · Dec 2, 2024

I too was nervous about teeth and dental work. I take it before any dental activity that creates a wound; An extraction, or root canal.
But I have not been taking it for any other type of dental maintenance. I have had no issues .

Johnpb · Dec 2, 2024

d333gs said:
I too was nervous about teeth and dental work. I take it before any dental activity that creates a wound; An extraction, or root canal.
But I have not been taking it for any other type of dental maintenance. I have had no issues .

Thanks for the reply. So you've never taken it before a cleaning??

And have you suffered any side-effects from taking it?

Johnpb · Dec 2, 2024

Johnpb said:
Thanks for the reply. So you've never taken it before a cleaning??

And have you suffered any side-effects from taking it?

d333gs said:
I too was nervous about teeth and dental work. I take it before any dental activity that creates a wound; An extraction, or root canal.
But I have not been taking it for any other type of dental maintenance. I have had no issues .

Also: What type of procedure did you have done? Valve replacement??

sharky7 · Dec 2, 2024

and there is another problem I was thinking of, aint it a proven fact when ya taking too much of those antibodies ya then can got so it doesnt work anymore, then what ya gona take? doesnt make sense to me, what am I missing?

BGold · Dec 2, 2024

Johnpb said:
I'm supposed to go to the dentist tomorrow for a cleaning, my first visit since valve replacement, and I've been prescribed 4 x 500 mg tabs of amoxicillin to take an hour before my appointment.

I'm very nervous about the appointment. I've read that amoxicillin can pose risk of stroke and I have a history of stroke, so... In addition, the prescription docs note that the risks associated with preventive antibiotics in most patients - adverse reactions and development of drug resistant antibacteria - outweigh any benefits.

I don't even feel safe to take the amoxicillin at home and then drive to my appointment. I'm more inclined to go early to the appointment and take it there. Am I overthinking this???

I have been taking amoxicillin for cleanings for 11 years with no issues. However I have no history of stroke.

dornole · Dec 2, 2024

Endocarditis is no joke and I imagine it raises your risk of stroke far, far more than taking a lone dose of amoxicillin.

The timing of the dose is to have it in your system Before the work, right? So taking it late makes no sense to me at all. Reducing your benefit while not changing your risk (which to me you’re overthinking.)

I’ve taken it many times for cleanings (back when it was recommended for some people with native valve disease) and I’ll be taking it again now that I have a mech valve. No side effects. Everyone with mech valves is at risk for stroke and all still recommended for dental premed so this is a known issue built into the recommendations.

The package warning against overuse is for parents insisting on antibiotics for their child’s clearly viral infections. Not for people at risk for endocarditis who need one dose twice a year. They are seeking to keep antibiotics effective FOR YOU.

You always retain choice but I do think you may be in the grip of anxiety and overthinking it. Personally I’d blame myself a lot more for ditching the recommendations and something went wrong than if I followed well established medical advice and something went wrong. You’re not even talking about one doctors opinion here but about written national guidelines.

Amy · Dec 2, 2024

If I’m remembering right, from what I’ve read here on the forum, there have been more horror stories about getting BE from not taking it early enough (say, only taking it 45 minutes before dental work, instead of more than a full hour before) than issues from the antibiotics themselves...

Having said that, I don’t know the stroke risk of those people..

I always took my premed before ‘anything that would cause any bleeding’ - so not initial exams or X-rays.

Having said THAT, if I knew the dental assistant cleaning my teeth was super gentle with the floss (finding someone like this is very rare though, and has only happened to me once) I might risk NOT taking a premed, so as not to have to deal with possible yeast infection-like symptoms later. (Or buying extra probiotics to take after the appointment)

(However, as far as I know, I don’t have a particularly high stroke risk...)

I don’t think this was helpful, but I just wanted you to know someone was listening, and understands well your anxiety about the situation. I’d never heard of amoxicillin increasing stroke risk. Now I’m a little (more) nervous for my next dentist appointment......

3mm · Dec 2, 2024

dornole said:
Endocarditis is no joke and I imagine it raises your risk of stroke far, far more than taking a lone dose of amoxicillin.

The timing of the dose is to have it in your system Before the work, right? So taking it late makes no sense to me at all. Reducing your benefit while not changing your risk (which to me you’re overthinking.)

I’ve taken it many times for cleanings (back when it was recommended for some people with native valve disease) and I’ll be taking it again now that I have a mech valve. No side effects. Everyone with mech valves is at risk for stroke and all still recommended for dental premed so this is a known issue built into the recommendations.

I strongly agree with dornole that Endocarditis is dangerous; you want to minimize your chances of getting it.

Amoxicillin is effective over a span of hours, so the timing of your dose can be slightly off, and it will still work.

Johnpb · Dec 2, 2024

dornole said:
Endocarditis is no joke and I imagine it raises your risk of stroke far, far more than taking a lone dose of amoxicillin.

The timing of the dose is to have it in your system Before the work, right? So taking it late makes no sense to me at all. Reducing your benefit while not changing your risk (which to me you’re overthinking.)

I’ve taken it many times for cleanings (back when it was recommended for some people with native valve disease) and I’ll be taking it again now that I have a mech valve. No side effects. Everyone with mech valves is at risk for stroke and all still recommended for dental premed so this is a known issue built into the recommendations.

The package warning against overuse is for parents insisting on antibiotics for their child’s clearly viral infections. Not for people at risk for endocarditis who need one dose twice a year. They are seeking to keep antibiotics effective FOR YOU.

You always retain choice but I do think you may be in the grip of anxiety and overthinking it. Personally I’d blame myself a lot more for ditching the recommendations and something went wrong than if I followed well established medical advice and something went wrong. You’re not even talking about one doctors opinion

Thanks for the comments, everyone!!! Awaiting my cleaning as we speak...

pellicle · Dec 2, 2024

Good morning

Johnpb said:
I'm very nervous about the appointment. I've read that amoxicillin can pose risk of stroke and I have a history of stroke, so...

first I've heard of this, so I googled it
I must say that Googles AI overview is pretty good these days (after all the tweaking its been getting)

The references:
https://www.nature.com/articles/s41...n increased risk,associated with a lower risk.

https://sph.tulane.edu/antibiotic-use-linked-greater-risk-heart-attack-and-stroke

https://pmc.ncbi.nlm.nih.gov/articl...tibiotic,adulthood with subsequent CVD events.

https://www.mdedge.com/cardiology/a...m-antibiotic-use-may-heighten-stroke-chd-risk

I think its pretty important to actually read the stuff which is used as the basis to say "may increase risk" and double down on the word "may" and what the context for that maybe is... I suspect however that such risk is related to long term use, not single administration.

Myself I've taken antibiotics for all dental cleaning since 1990's ... never had a stroke.

I've also had a period of my life (starting a year after OHS#3) where I was on amoxcillin for ten years. Also never had a stroke. I was only on warfarin after OHS#3 (where I got a mechanical) and so that may have helped.

skeptic49 · Dec 2, 2024

I have been taking Amox before dental work for 10 years since my AVR . I apparently had some small strokes prior to AVR probably due to Lambl’s excrescences. However, I have not had any cerebral events (TIA'a) since AVR to my knowledge. My dentist recently advised that antibiotics can be taken up to a few of hours after dental work and still be affective in preventing endocarditis.

JLmatus · Dec 2, 2024

No worries. I've been taking antibiotics for the last eight years before dental procedures. Never had a problem.

dick0236 · Dec 2, 2024

Like the others who have responded I have taken Amoxicillin prior to dental work the past +/-25 years with no issues. I didn't take it earlier because it was not a protocol in the '70s-'90s.

carolinemc · Dec 3, 2024

Johnpb said:
I'm supposed to go to the dentist tomorrow for a cleaning, my first visit since valve replacement, and I've been prescribed 4 x 500 mg tabs of amoxicillin to take an hour before my appointment.

I'm very nervous about the appointment. I've read that amoxicillin can pose risk of stroke and I have a history of stroke, so... In addition, the prescription docs note that the risks associated with preventive antibiotics in most patients - adverse reactions and development of drug resistant antibacteria - outweigh any benefits.

I don't even feel safe to take the amoxicillin at home and then drive to my appointment. I'm more inclined to go early to the appointment and take it there. Am I overthinking this???

You were given misinformation, from the often-wrong internet. Not from the Cardio or the dentist. You were over thinking with misinformation. Many people die without premedication of antibiotics. Benefits of premedication outweighs any issues after. It is fine to take at the dentist office, for I was lucky when I had a reaction to Amoxicillin, for anyone that has been taking penicillin takes a chance when you take antibiotics of a reaction of years of taking it.
You should have been fine yesterday; it takes years to build up the resistance to Amoxicillin.

Gail in Ca · Dec 3, 2024

I’ve taken antibiotics before dental appointments since we had to have 2 shots in the buttock of 2 antibiotics before appointments. You are lucky they changed the recommendation to capsules!

Chuck C · Dec 3, 2024

Hi John.

Johnpb said:
I've been prescribed 4 x 500 mg tabs of amoxicillin to take an hour before my appointment.

This is exactly what is called for by the guidelines of the American Medical Association (AMA) and also the American Dental Association (ADA), for patients with prosthetic heart valves, both biological and mechanical.

For the vast majority of patients, the very small risk posed by amoxicillin is likely greatly outweighed by the reduction in risk for endocarditis. As for your specific situation and whether the risk is worth the reward, I suspect that the benefit outweights the risk, but that is a question that your cardiologist should be able to help you navigate.

Personally, I've been taking 2,000mg of amoxicillin an hour prior to dental visits for the past 4 years. No negative side effects that I am aware of.

Lisa from LJ · Dec 3, 2024

After having Rheumatic Fever and Bacterial Endocarditis, I took Penicillin shots every month for about 5 years, then some form of oral Penicillin for another 5 years. I did have to take stronger and stronger doses because of it wasn't working as well after so long on it. Then the "gold standard" treatment for those who'd had RF changed (they decided the risk of becoming "immune" to it and I stopped taking it except if I had a strep infection or teeth cleaning. I had Valve Replacement 22 years after RF and still take it if I get strep or for teeth cleanings. I've never had an issue.

Lisa from LJ · Dec 3, 2024

sharky7 said:
and there is another problem I was thinking of, aint it a proven fact when ya taking too much of those antibodies ya then can got so it doesnt work anymore, then what ya gona take? doesnt make sense to me, what am I missing?

The small amount you take for teeth cleaning twice a year is not "too much" and even if you have to take more for dental treatment or an occasional bacterial infection, it's still not going to be enough. I took antibiotics for 10 straight years and didn't start becoming "immune" to it until about 5 years out. Then I took higher doses and eventually stronger forms of Penicillin.

Lisa from LJ · Dec 3, 2024

dick0236 said:
Like the others who have responded I have taken Amoxicillin prior to dental work the past +/-25 years with no issues. I didn't take it earlier because it was not a protocol in the '70s-'90s.

Interesting. I took Penicillin for 10 straight years beginning in 1976, but when I went off it in 1986 I always pre-medicated before I went to the dentist. I hadn't had VR yet at that point, so this was because I'd had Rheumatic Fever. My valve replacement was in 1998 and the pre-medication continued.

Amoxicillin before a dental cleaning: tooth or consequences...

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