Dental Care ~ 1st appointment to the denist in a month, previous endo, worried!

[Sash]

Hi All,

I had endocarditis last year due to a deep cleaning and its going to one year since my surgery, met with my cardio yesterday and he's a little upset that I haven't see a dentist yet.

I am obviously traumatized by deep cleaning (and flossing), so I had a couple questions. (forgive me if they sound a little silly)

How often do you brush? (I am used to once a day with mouthwash at night, just converted to twice a day until recently)

Do you floss regularly?

Do you deep clean at the dentist? (cario says twice a year, I was told that deep cleaning is somewhat of a myth, and regular cleanings with proper dental care should be fine, anyone have info on this)

Any help feedback, thoughts would be great.

I hate the dentist.

Thanks,

Sash

 

[maisiejane]

Hi Sash,
I haven't experienced endocarditis, I see my dentist 4 times a year this is for 2 dental checks and 2 deep cleans. My last deep clean was 2 weeks before my AVR surgery which was scheduled for 6th Jan, 1 week after my deep clean I began to have problems with my teeth, I went into hospital as arranged but I was experiencing pain, the pain was diagnosed as an abscess which meant 2 hours before my arranged surgery I was discharged. I feel it was because of the deep clean as I haven't had any problems for many tears, my dental routine is morning / evening - 2 minute brushing, flossing and mouth wash. If I had a choice I wouldn't have the deep cleans but is part of the package at my dentist. No matter how well you look after your self these things can and do happen and it is just unfortunate.
Take care
Deb x

 

[Onx_06]

Hi Sash,
I would go for regular cleaning - and make sure you tell the Dentist that you do not want deep - gum cleaning. Of course, no matter which route you go - take the antibiotics (usually amox 4 tablets 500 mg each) .. My dentist recommends twice a year .. just not worth the risk.. my .02

 

[dick0236]

Hi Sash,
I would go for regular cleaning - and make sure you tell the Dentist that you do not want deep - gum cleaning. Of course, no matter which route you go - take the antibiotics (usually amox 4 tablets 500 mg each) .. My dentist recommends twice a year .. just not worth the risk.. my .02

This is what I do as well. Don't forget the amoxicillin(sp).

 

[Duffey]

I think daily flossing is important, and I brush twice, sometimes three times a day, but I don't think you necessarily want the deep cleaning.

 

[AZ Don]

This would have been a timely discussion for me ... yesterday. I just went to the dentist yesterday with a plan to only have a simple cleaning. The dentist made the case that I needed a deep cleaning. She mentioned that a regular cleaning would not get the bacteria in the deeper pockets and it could actually push bacteria into those pockets. Since I had taken antibiotics, the risk of an infection from the cleaning should be minimal, so the risk to consider then is the risk between Dental appointments. The more bacteria under my gum line, the more risk there is of it getting into my bloodstream while flossing. And if I don't floss then the bacteria would build up and my gums could weaken - and then more risk of it getting into my bloodstream.

The way I look at it is that the best way to minimize the risk of infection is to take good care of my teeth and gums, and if they require a deep cleaning then that's what they need. When I got home I looked up periodontal disease and the first line of treatment recommended is a deep cleaning. I brush and floss daily, so it is frustrating to me that I needed a deep cleaning.

 

[Jkm7]

I pre-medicate with amoxicillan and have deep cleaning four times a year.

 

[epstns]

OK - What is the difference between regular cleaning and "deep" cleaning?

I have what I believe to be regular cleaning done four times a year, each time I pre-medicate with 600 mg of clindamycin (I don't tolerate amoxicillin or penicillin derivatives well). Normal brushing and flossing is recommended. If you keep things well-maintained, I think your risk of endocarditis from normal personal hygiene is minimal to none. Pre-medication for dental work is now even thought to be optional, but my cardio, my dentist and I agree better to be safe than sorry.

 

[Eva]

The moment I wake up, using a very soft brush, I brush lightly to get rid of any acids formed during the sleep.

It takes twenty minutes for bacteria and plaque to form after a meal. So, I try to floss or brush after each meal to avoid oration of pockets in the gum where the bacteria will dwell. If pockets are not treated, there is a chance for bacteria to travel brought the blood to other parts of the body, including the heart.

My main floss is at night in front of a magnified mirror to make sure no residues are missed!
When I'm a bit tired in the evening, I would still and definitely floss preliminarily while watching TV, and brush later with a round electric toothbrush.

I see my dentist four times a year. I premedicate with 2000 mg of Amoxicillin one hour before treatment.

 

[ottagal]

Hi Sash,
No question here is a silly one!
You may be interested in reading the article below: in particular, advice to patients and conclusion.

One of the most important things we can do to prevent endocarditis is daily practice of excellent oral hygiene which means brushing thoroughly at least twice a day and regularly as well as daily flossing (which reaches the interproximal surfaces of the tooth that the toothbrush doesn't reach). Eva explained her hygiene practice well. Of course, I don't know your personal dental history i.e. do you have periodontal disease etc. that requires more frequent and involved periodontal scaling? That would be something that should be discussed with your dental hygienist and dentist.

FWIW...Over 500 different types of bacteria live in our mouths so it is impossible to eliminate all bacteremia . We do need some of the our normal oral flora(good bacteria) for homeostasis (OK..enough of the scientific stuff) . However, we want to keep the overall 'bad bacterial load' down in our mouth.

As quoted by the author of the article below "Episodes of bacteremia from daily activities may be reduced by the maintenenance of optimal oral health, which is likely more effective in preventing endocarditis than prophylactic antimicrobial therapy for dental procedures." Of course, he acknowledges that for those of us that fit in the category of being in the higher risk category of developing bacterial endocarditis i.e. artificial heart valves, previous endocarditis etc. 'prophylactic antibiotics' is recommended.

I guess what I am saying is meticulous 'daily' hygiene is possibly one of our better defenses in helping reduce our chances of developing endocarditis .

Of course, I haven't had the experience of developing endocarditis, so I can imagine why you would be experiencing trepidation with your past history.

Wishing you all the best!

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643171/

 

[ski girl]

"If you keep things well-maintained, I think your risk of endocarditis from normal personal hygiene is minimal to none"

I wish! I got acute endocarditis (mouth bacteria) 11 months after AVR with a tissue valve and was so sick I had only a 30% chance of living to, and then through, my emergency AVR redo.

I had a wonderful infectious disease specialist who gave me the following pointers:
* Rinse with Listerine (or equivalent antibacterial mouthwash) before you brush your teeth
* Wait a few minutes after spitting out to give the mouthwash time to kill everything
* Floss daily, using tape floss (not the string, it's more likely to cut your gums)

He also said the most important thing to do before seeing the dentist isn't the antibiotic pre-meds (although in my case he recommends it!) - the most important thing is to do antibacterial rinses before they get their poky instruments into your mouth. So when I see my dentist for a regular cleaning (never heard of a deep cleaning, sounds like a bit of a crock that dentists may have made up to extract more money from you???) I rinse before I go, then before they start, at some point during the cleaning, then afterwards again.

I wish I had been told this after my first op, not after I almost died from endocarditis!!!

 

[AZ Don]

I had a wonderful infectious disease specialist who gave me the following pointers:
* Rinse with Listerine (or equivalent antibacterial mouthwash) before you brush your teeth
* Wait a few minutes after spitting out to give the mouthwash time to kill everything
* Floss daily, using tape floss (not the string, it's more likely to cut your gums)

He also said the most important thing to do before seeing the dentist isn't the antibiotic pre-meds (although in my case he recommends it!) - the most important thing is to do antibacterial rinses before they get their poky instruments into your mouth. So when I see my dentist for a regular cleaning (never heard of a deep cleaning, sounds like a bit of a crock that dentists may have made up to extract more money from you???) I rinse before I go, then before they start, at some point during the cleaning, then afterwards again.

Good advise, thanks for sharing.

 

[MrsBray]

Daily: Brush 2X w/electric toothbrush, floss nightly, energetic anti-bacterial rinse (non-alcohol based because it dries out my mouth, and that's the last thing I want when using a cPAP)
2X a year: Regular cleaning with 2000mg amoxicillin pre-med

This is what my hygienist recommends, my DDS recommends, and my cardio agrees with.

I also swich with coconut oil several times a week, and keep a toothbrush/floss in my car for when I'm bored driving.

 

[epstns]

I think I get it now. . . DEEP cleaning means that they reach DEEP into your pocket. Makes sense.

 

[Agian]

Does anyone here use Chlorhexidine mouthwash?

 

[pellicle]

one more for the antibiotics PRE any dental procedure. My dentist won't let me in the chair unless I've said yes, and then YES one more time.

 

[ottagal]

Does anyone here use Chlorhexidine mouthwash?[/QUO

This is the pre-procedural rinse that is used at my dental office. I rinse for 1 minute prior to starting any dental procedures.I was told it has a higher substantivity rate than Listerine so its effects will last longer during the dental procedure. However, both are good antibacterials. I also take the prophylactic amoxicillin as others do. This is the first question my dentist/dental hygienist also asks me.

SkiGirl Quote: "If you keep things well-maintained, I think your risk of endocarditis from normal personal hygiene is minimal to none"

Gee, who quoted you that? My understanding is we can do our best to help reduce the chances of developing endocarditis through meticulous dental hygiene, but it seems to me that they don't always know where the bacteria come from and my understanding was endocarditis could develop for other reasons other than being dentally related. Perhaps, I am wrong.

Also, Thanks for the bringing up the pre-rinsing BEFORE brushing and flossing. Excellent points.

 

[dornole]

Re: deep cleaning, if you are getting this, YOU WILL KNOW. I have had this in the past from the mean hygienist and dentist who also sent me to the periodontist who wondered why I was there. Left my gums bleeding and in pain. Go to different folks now who seem to think it is not necessary for me.

Great info on this thread that I will be putting to use!

 

[Rachel]

Does anyone here use Chlorhexidine mouthwash?

I had to use it for about a year - since I almost destroyed my gums by using the Listerine!!!

Note to anyone using Listerine - use Listerine Zero instead of straight Listerine.... to prevent dry mouth which could lead to (as in my case) an increase in very scary and harmful bacteria - the exact opposite of what you want!

I was very lucky mine didn't lead to something worse........

 

[AZ Don]

FYI, I looked up pre procedural mouth rinse and found that in 1997 the American Heart Association recommended it, but it was dropped in their current guidelines. The current guidelines are here: http://www.heart.org/HEARTORG/Condi...Infective-Endocarditis_UCM_307108_Article.jsp

A discussion of the mouth rinse and changing guidelines are here: http://www.afms.af.mil/shared/media/document/AFD-130402-130.pdf

... the most recent AHA infective endocarditis recommendations published in 2007, reviewed the scientific evidence relating to endocarditis prophylaxis and concluded that the "results are contradictory with regard to the efficacy of the use of topical antiseptics in reducing the frequency of bacteremia associated with dental procedures, but the preponderance of evidence suggests that there is no clear benefit."

Still I don't think it can hurt and so I plan to do it before flossing and dental work.

To give an idea of the difference between a cleaning and a deep cleaning, the mouth is normally fully numbed for a deep cleaning, the way part of it would be for a cavity repair.