A tale of Endocarditas and valve replacement.

[ottagal]

In the US, they recommended oral antibiotics for all tooth cleaning if you have a mechanical valve of any type and in any position. I don'take to it too well and about 2 years ago asked if it was necessary. My cardiologist said yes. When I pushed and asked if there was any hard evidence, he emphatically stated that in his personal experience he has had patients get endocarditis from simple dental work.

One person on here had endocarditis and was told by their infectious disease specialist to use an oral disinfectant (e.g. Listerine) before any dental procedure. My dentist is quite happy to let me rinse at the beginning

FWIW...I always pre-rinse with chlorhexidine before any dental procedures at the dentist. I would insist on doing this. If you have to, bring your own Listerine to pre rinse with beforehand if the office doesn't have any.

 

[ottagal]

Glad to hear you are on the mend. That was quite an ordeal, James Redman. One day at time....recovery is a process...

 

[carolinemc]

very much like mine, a St. Judes' leaflet valve. Good one. Thanks for information. Hugs for today.

 

[carolinemc]

FWIW...I always pre-rinse with chlorhexidine before any dental procedures at the dentist. I would insist on doing this. If you have to, bring your own Listerine to pre rinse with beforehand if the office doesn't have any.

but mouthwash does not help prevent infection from cleaning or dental work from going down to the heart. There have been many stories of death from not getting premed first before any dental procedure. Please talk to your cardio or PC about getting antibiotic premed for infection prevention. Hugs for today.

 

[ottagal]

but mouthwash does not help prevent infection from cleaning or dental work from going down to the heart. There have been many stories of death from not getting premed first before any dental procedure. Please talk to your cardio or PC about getting antibiotic premed for infection prevention. Hugs for today.

One still needs to take antibiotic prophylactically, but the anti bacterial mouthwash will reduce the overall bacterial load in the mouth topically , not subgingivally. I should have been more clear stating that mouthwash IN ADDITION to the antibiotic prophylaxis... p.s. many years ago, I worked in the dental field....

 

[carolinemc]

One still needs to take antibiotic prophylactically, but the anti bacterial mouthwash will reduce the overall bacterial load in the mouth topically , not subgingivally. I should have been more clear stating that mouthwash IN ADDITION to the antibiotic prophylaxis... p.s. many years ago, I worked in the dental field....

Never heard anything about using mouthwash to prevent infection of the gums or teeth from going down to the heart when the infection is in the blood stream. Please send me a way to get this unbelievable information. For I have been a cardio patient since birth.

 

[ottagal]

Never heard anything about using mouthwash to prevent infection of the gums or teeth from going down to the heart when the infection is in the blood stream. Please send me a way to get this unbelievable information. For I have been a cardio patient since birth.

carolinemc: I am confused by your angry emoji. I never said what you are quoting me as saying.
I said it will reduce the overall bacterial load IN the mouth topically NOT subgingivally (which means below the gum line) . I did not say to not take antibiotics as suggested by the guidelines and cardiologists for the individual's specific case. The dental office I go to has me do a pre procedural mouth rinse prior to my dental cleanings IN addition to the antibiotics.

Standard procedure before AVR at the hospital I went to had all patients rinse before their cardiac surgery with chlorhexidine mouth wash to reduce bacterial count in their mouth.

Have a nice day.

Here is a systematic review and meta analysis on chlorhexidine benefits prior to cardiac surgery. thttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802585/

Conclusions
Perioperative oral chlorhexidine significantly decreases the incidence of nosocomial infection and postoperative pneumonia in patients undergoing elective cardiac surgery.

 

[mina]

After my OHS my dentist also recommend that I use Listerine daily - for the reasons ottagal mentioned. I got bacterial endocarditis from a dental cleaning (I had a BAV).

FWIW, my most excellent cardiologist has said that there's really no good evidence that premeds will prevent endocarditis - but he also said that I might as well premed because there isn't much harm in doing so.

ETA: glad you made it through, James! And the rest of you, too. My endocarditis story is much the same as all of yours.

 

[pellicle]

Please forgive me....long time..3 months lurker..first post here. Love the collective knowledge.
Sooo... Started feeling under the weather October 2018, visited my regular Dr. Lots of blood work then PET scans, MRI and even a visit to an Oncologist/Hemotologist. No clear answer except white blood cell count was up.

I found those posts by Ski Girl
https://www.valvereplacement.org/threads/infective-endocarditis.40451/

also worth a read:
https://www.valvereplacement.org/threads/endocarditis-is-a-nightmare.40523/#post-742666

 

[normofthenorth]

I've also adopted the routine of rinsing with antiseptic mouthwash at the start of my dental home care (2x/day) and my dental professional care.
At home I use the cheapest amber Listerine imitation I can find. I don't avoid alcohol and I usually add a splash of warm water to the squirt of near-Listerine.
I can't prove that it's keeping me safe from endocarditis (touch wood!) but I'm getting raves from my hygienists!

 

[normofthenorth]

I've also adopted the routine of rinsing with antiseptic mouthwash at the start of my dental home care (2x/day) and my dental professional care.
At home I use the cheapest amber Listerine imitation I can find. I don't avoid alcohol and I usually add a splash of warm water to the squirt of near-Listerine.
I can't prove that it's keeping me safe from endocarditis (touch wood!) but I'm getting raves from my hygienists!

The key ingredients, besides alcohol, seem to be Eucalyptol ( = eucalyptus oil), Thymol ( = Thyme oil) and Menthol ( = mint oil).

 

[tumblindice]

At age 61, late in 2017, I had been feeling sick for a few months. Intermittent fever, chills, night sweats. Shortness of breath getting worse and worse. Got a nose bleed that would not stop. Platelet count very low, rushed to emergency room. Treated for a week with steroids and released. They thought I had rare blood disease, Evan's Syndrome, and began weekly infusions of Rutuxan, a drug also used for chemo in some cancers. Prognosis uncertain.

A month later a monster pain in my lower left side and back to the emergency room. It hurt like hell every time the ambulance went over a bump. A very wise doctor called for an ultrasound of my heart. I had large endocarditis vegetation about 1.5 x 1.5 cm om my aortic valve causing it to malfunction. I had no idea that I had a heart problem. The pain was from a piece of vegetation that had broken loose and lodged in my spleen and/or kidney. Blood cultures showed enterococcus faecalis bacteria. Less than a week after admission they went in and replaced 2 valves in Feb 2018, aortic and mitral, both tissue valves. Conventional open-heart surgery, 7.5 inch vertical scar on my sternum. I had to get PICC line IV infusion of antibiotics every 4 hours for 6 weeks after surgery. The good news is that they did not see any reason to do bypasses while they were in there.

Later, I requested the medical record of my surgery. Some drama. They went in and replaced the aortic valve as planned. Tried to take me off the heart-lung machine and my heart started but was not pumping enough. Put me back on the machine and opened my left atrium and replaced my mitral valve. Heart pumped good, problem solved, closed me up.

Doctors made it sound like recovery was a breeze, saying people are up and around in a few days, out of the hospital in a week. True, I was up and out of the hospital in a week, but nobody mentioned the profound overall weakness and difficulty in just walking. Took me weeks to feel confident on my feet again.

Obviously, I could have died. They were going to operate in a few days, but then rushed me into surgery right away. The medical report said my heart was "decompensating" before surgery. But after 16 months, no complications, no fever/chills, no shortness of breath, no pain, no atrial fibrillation or other heart issues. Can walk fine, drive, mow the lawn, shovel snow. I feel great with no changes in lifestyle. I'm very very lucky that it turned out so well.

My platelets and all other blood cells returned to normal. No rare blood disease. The endocarditis was driving a weird reaction in my blood.

 

[carolinemc]

carolinemc: I am confused by your angry emoji. I never said what you are quoting me as saying.
I said it will reduce the overall bacterial load IN the mouth topically NOT subgingivally (which means below the gum line) . I did not say to not take antibiotics as suggested by the guidelines and cardiologists for the individual's specific case. The dental office I go to has me do a pre procedural mouth rinse prior to my dental cleanings IN addition to the antibiotics.

Standard procedure before AVR at the hospital I went to had all patients rinse before their cardiac surgery with chlorhexidine mouth wash to reduce bacterial count in their mouth.

Have a nice day.

Here is a systematic review and meta analysis on chlorhexidine benefits prior to cardiac surgery. thttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802585/

Conclusions
Perioperative oral chlorhexidine significantly decreases the incidence of nosocomial infection and postoperative pneumonia in patients undergoing elective cardiac surgery.

It is by the American Dental Association and American Heart Association that heart patients have antibiotic regiment before any dental procedure, cleaning and dental work. I have done this for many years. Mouthwash does nothing for infection already in the teeth and gums. You had only said that you did only dental rinse with mouth wash before any dental procedure. Please be careful and explain everything in detail. We have new people to heart disease and are look for complete information. It does not prevent infection already in the teeth and gums from going down into the heart.

 

[normofthenorth]

I think my illness is pretty easily and obviously traced back to dental work. I started felling ill about 2 weeks after. I had non-acute endocarditis. I have had mono and that's what it felt like...as a matter of fact thats what I thought it was and the drs. sure didn't have a clue. So I just felt like crap for 4 months.

Some of the best advice I got here was rinsing with listerine before and after brushing. No clue if it keeps me well but terrible mouth ulcers have plagued me forever and they completely disappeared. My teeth and gums look great also. So I am a believer in that either way lol.

My dentist stays with the antibiotic myth. I go along but I think there is pretty good data out there it probably does not mean much.

Listerine is great, but "the antibiotic myth" turns out to be TRUE! And Amoxicyllin turns out to be pretty benign, too. I think you can find links to two good studies on my long thread that I've been treating as a personal timeline.
A few years ago I was on the verge of quitting the Amoxicyllin pre-med before oral cleaning, which I get at my dentist and my periodontist. The evidence for benefits seemed very weak, and every month seems to bring more evidence (or press) about the importance of our gut flora "biome" for our wellbeing, so why am I wiping out mine ~3x/year for maybe no benefit, right?
I'm an MIT graduate, so I know how to read research results, so I started Googling before giving up the Amoxicyllin. Results here from memory:
First result: maybe a decade ago, the UK responded to the weak evidence by changing their guidelines for antibiotic pre-med for heart patients. They went much farther than the AMA & ACA (& Canadian counterparts) and they stopped recommending the pre-med for ALL of us.
At first, that encouraged me to proceed. But a few years had passed since that change - and I read that the UK had experienced a significant increase in endocarditis incidence and mortality among the affected population! AFAIK, they have changed their guidelines again, and now agree with the North American guidelines.
So the "myth" seems to be true!
But even if there is a significant benefit, is it big enough to justify wiping out my gut flora - maybe even continuously, if the effects last for a few months (from one oral cleaning to the next)?
Then I found the second study: a multi-center RCT that monitored gut flora in a bunch of patients who took maybe 4 different antibiotics. One was Amoxicyllin, one was Cipro, and there were 2 others. Gut flora were analyzed in detail before the antibiotics and at several intervals afterwards, up to a year (or two?) later.
Some of the results were scary - Cipro takers still had flora effects a year later!
But Amoxicyllin takers returned to "pre-pre-med" flora readings very quickly. Significant rebound in a day and essentially total recovery in a week!
There was one metric that didn't show complete recovery: all the patients' gut bacteria showed higher proportions of antibiotic-resistant variants than before, and compared to other "control" subjects who didn't take the antibiotics. (I think that effect is unavoidable: if you kill all the susceptible bacteria, the survivors and their progeny will be less susceptible.)
I tolerate Amoxicyllin fine, and its results were the best in this study, and almost totally benign and temporary. So I abandoned my plan to stop my pre-med and I shared my journey on my "timeline". And now I'm pretty happily pre-medicating with Amoxicyllin ~3x/yr before I get my teeth scraped.
Anybody, if you want the links and can't find my old post, let me know and I'll post a link to it.
And more:
1) I haven't continued to research this, so it's possible that there is newer information. (Always!)
2) I was already avoiding the Cipro family of antibiotics for other reasons - it is implicated in tendon ruptures and I've already ruptured both of my Achilles tendons and a finger tendon (all while playing competitive volleyball). But they were also the worst in the gut flora study, so I'll keep avoiding them unless/until I get an infection that doesn't respond to anything else.

 

[normofthenorth]

...

FWIW, my most excellent cardiologist has said that there's really no good evidence that premeds will prevent endocarditis - but he also said that I might as well premed because there isn't much harm in doing so.
...

Mina, with all due respect to your excellent cardiologist, I think the relatively recent real-world experience of the UK provides "good evidence that premeds will prevent endocarditis". I've posted more in a Reply on the previous page, and even more a few years ago elsewhere on this site.

The "isn't much harm" part seems to depend on the antibiotic used, and there's pretty good data on that too.

 

[sue943]

Welcome James.

I got my endocarditis from having treatment for kidney stones back in 2004 and they didn't prescribe any antibiotics which were recommended for the procedure, I later discovered. I developed endocarditis but didn't realised, was just very unwell for about 10 days or so, then afterwards just not feeling well, which was when it went sub-acute. Vegetation was growing and about 10-12 weeks later some broke off and caused a stroke. The endocarditis flared again and was discovered when I was in hospital with the stroke. I had the stroke on 12th March 2005 and didn't come out of hospital until late April having been on intravenous antibiotics. The endocarditis was cleared but my mitral and aortic valves were damaged and I went into heart failure. I had both replaced on 30th June that year and am now fine.

I have had kidney stones treated twice since without any further problems, unless you could sepsis which was my second lot of kidney stones making themselves known! Now I have annual x-rays to check if they have grown back.

 

[pellicle]

I got my endocarditis from having treatment for kidney stones back in 2004 and they didn't prescribe any antibiotics which were recommended for the procedure, I later discovered. I developed endocarditis but didn't realised, was just very unwell for about 10 days or so, then

glad you're still with us

 

[Duffey]

It is by the American Dental Association and American Heart Association that heart patients have antibiotic regiment before any dental procedure, cleaning and dental work. I have done this for many years. Mouthwash does nothing for infection already in the teeth and gums. You had only said that you did only dental rinse with mouth wash before any dental procedure. Please be careful and explain everything in detail. We have new people to heart disease and are look for complete information. It does not prevent infection already in the teeth and gums from going down into the heart.

Caroline, Ottagal didn’t say it reduced previous infection in teeth or gums. She said it reduced the overall bacteria count found in the mouth.

 

[James Redman]

To add onto my initial post. I had a left front tooth damaged/broken at 12 years old. Boarding school accident, face first onto the dorm floor. Trying to get the longest slide on a travelling rug. Fast forward 40 odd years. Tooth came out broke the post...sooo emergancy dental work.
Tooth pulled and no prophylactic anti biotics
Got sick soon after, as mentioned above a long time to diagnose IE.
Still the docs said the vegatative growth was well established before the dentist visit.
Any way... IE got me...
All is good now.

 

[ottagal]

Caroline, Ottagal didn’t say it reduced previous infection in teeth or gums. She said it reduced the overall bacteria count found in the mouth.

Thank you, Duffey. At least someone is reading and understanding what I am/was saying. I have clarified in a few posts now for the above person and will now remove myself from responding to any further comments on this post.