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

[dwhist]

I have been doing the Amoxicillin for dentist since new valve in 2011. Since then I have had a knee and shoulder replacement. For both of the joint replacements, I was told I needed to premedicate for dental work, which I was already doing. My dentist office told me if I ever showed up and forgot to take it, they kept some on hand.

 

[Amy]

It is fine to take at the dentist office

If you wait to take it at the dentist, you need to be sure to wait the FULL hour , and not be intimidated by them rushing you to begin the dental work, which of course they will do.

 

[erricojj]

It's best to follow protocol on this, Johnpb. The risk is real. A member of my extended family went for a cleaning without taking his premed and it cost him a week in the hospital, and almost his life, due to endocarditis.

For added protection, I use a water-pic every day. This will keep your gums cleaner and reduces risk.

I premed before every dental appointment, regardless of type of visit. Even a "non-invasive" procedure can involve probing around gum lines where bacteria hang out.

One of my dentists includes a premed reminder in his text message appointment reminders.

Obviously, there's no quarantees that we will avoid endocarditis by these practices, but the odds are with us.

 

[Lisa from LJ]

If you wait to take it at the dentist, you need to be sure to wait the FULL hour , and not be intimidated by them rushing you to begin the dental work, which of course they will do.

Not accurate. The guidelines from the American Heart Association say, “If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure.”

 

[d333gs]

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

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

No side-effects. And , not before cleaning .

 

[Yankeeman2]

I have been doing the Amoxicillin for dentist since new valve in 2011. Since then I have had a knee and shoulder replacement. For both of the joint replacements, I was told I needed to premedicate for dental work, which I was already doing. My dentist office told me if I ever showed up and forgot to take it, they kept some on hand.

I'd be wary of agreeing to take whatever pills any dentist offered. I always remember to take my meds before having teeth cleaned.

 

[oo0My_Valve0oo]

Not accurate. The guidelines from the American Heart Association say, “If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure.”

That will depend on the dentist. Not that anything is up for debate but you will have to convince some. The office has rules in place, accurate or not. Sometimes only a hygienist is present. The dentist may not be available to change their position on the matter. So far I am two for two dentists believe it is an hour before the procedure or they reschedule.

 

[erricojj]

The protocol of 1 hour before procedure is not arbitrary assuming the intent is have peak concentration during the procedure to avoid blood borne bacteria from gaining a foothold. Amoxicillin has a relatively short half-life at around 1 hour.

See NIH article...

https://www.ncbi.nlm.nih.gov/books/NBK482250/

Pharmacokinetics

Absorption: Amoxicillin exhibits stability in the presence of gastric acid and is rapidly absorbed after oral administration, with average peak blood levels typically reached within 1 to 2 hours.

Elimination: Amoxicillin has an approximate half-life of 61.3 minutes, and about 60% of the administered dose is excreted in the urine within 6 to 8 hours. Co-administration of probenecid can delay amoxicillin excretion, as the majority of the drug is eliminated unchanged in the urine.

 

[Eva]

The protocol of 1 hour before procedure is not arbitrary assuming the intent is have peak concentration during the procedure to avoid blood borne bacteria from gaining a foothold.

Absorption: Amoxicillin exhibits stability in the presence of gastric acid and is rapidly absorbed after oral administration, with average peak blood levels typically reached within 1 to 2 hours.
…..

Exactly! It’s much safer to take antibiotics one hour before treatment! Knowledgable/caring dentists won’t accept to clean one’s teeth if not pre-medicated!

 

[Lisa from LJ]

That will depend on the dentist. Not that anything is up for debate but you will have to convince some. The office has rules in place, accurate or not. Sometimes only a hygienist is present. The dentist may not be available to change their position on the matter. So far I am two for two dentists believe it is an hour before the procedure or they reschedule.

The statement I said wasn't accurate was that you should insist that they wait the full hour. Both of the dentists that I've seen in the last 30 years will give me the meds at the front desk if I forget to take them, but I have no doubt that some offices may have different rules.

 

[Lisa from LJ]

The protocol of 1 hour before procedure is not arbitrary assuming the intent is have peak concentration during the procedure to avoid blood borne bacteria from gaining a foothold. Amoxicillin has a relatively short half-life at around 1 hour.

See NIH article...

https://www.ncbi.nlm.nih.gov/books/NBK482250/

Pharmacokinetics

Absorption: Amoxicillin exhibits stability in the presence of gastric acid and is rapidly absorbed after oral administration, with average peak blood levels typically reached within 1 to 2 hours.

Elimination: Amoxicillin has an approximate half-life of 61.3 minutes, and about 60% of the administered dose is excreted in the urine within 6 to 8 hours. Co-administration of probenecid can delay amoxicillin excretion, as the majority of the drug is eliminated unchanged in the urine.

While all of that is true, antibiotics don't just work at their peak time and taking them at the time of treatment or even up to a couple of hours later is still acceptable according to the AHA guidelines. While the bacteria may not be in the blood before the peak time, the antibiotic will still have time to kill the bacteria before damage occurs.

Think about the following two scenarios:

You take your antibiotics one hour before your dental appointment. You get stuck in traffic and arrive 30 minutes late and have to wait 20 minutes since you're now considered a "walk-in." After a quick exam, your cleaning begins 2 hours after you took the antibiotics and continues for 30 minutes. Are the antibiotics no longer beneficial?

You wake up with a sore throat and assume you have drainage. It doesn't go away so the next day you call to make an appointment to see your PCP. He/she can see you the following day. You're diagnosed with strep and are given a prescription of antibiotics. Are the antibiotics no longer beneficial since the bacteria has been in your body 2 plus days?

 

[Lisa from LJ]

Exactly! It’s much safer to take antibiotics one hour before treatment! Knowledgable/caring dentists won’t accept to clean one’s teeth if not pre-medicated!

I agree with your second sentence. Your third sentence doesn't follow the AHA or ADA guidelines and knowledgeable dentists should know the guidelines. One hour before is best. At the time of treatment or up to two hours later is acceptable.

 

[Eva]

At the time of treatment or up to two hours later is acceptable.

Lisa, Your reference to the AHA guidelines piqued my interest. After my surgery, all four cardiologists and my primary care physicians advised me to take Amoxicillin one hour before any dental procedure. When I inquired about the necessity of a second dose due to my condition and a desire for extra precaution, they assured me that I would be protected for 12 hours, despite the half-life of Amoxicillin.

 

[Lisa from LJ]

When I inquired about the necessity of a second dose due to my condition and a desire for extra precaution, they assured me that I would be protected for 12 hours, despite the half-life of Amoxicillin.

Like Warfarin, there are many factors that determine how long it stays in your body - metabolism, liver and kidney function, age, etc. Since the recommended dose is every 8-12 hours, I'd guess at least 12 hours. That's why knowledgeable and caring dentists will go ahead with the treatment even if it hasn't been an hour. They know that getting a patient in the dental chair can be difficult so better to treat while they're there as bacteria in the mouth is more of a danger when dental work is skipped.

 

[carolinemc]

If you wait to take it at the dentist, you need to be sure to wait the FULL hour , and not be intimidated by them rushing you to begin the dental work, which of course they will do.

I go by what the dentist says, two, 2 hours before appointment, then take 2, 4 hours later.