Dental Meds

[inventory]

Hello Everyone
Just a quick question. I was just at my
Dentist and of course he asked me if
I took my meds for the cleaning.
He said that he just read that after 3 or
more years you don't have to take them
any more, but to check with my Doctor
just in case.
Have any of you heard or had any experiences
where we shouldn't take the medication after
3 or more years for Dental cleanings or work?
That would also go for any other procedures
we have where we would also take the meds.
Thanks for any replies.
Al

 

[WayneGM]

There's been several threads talking about whether or not antibiotics are necessary before dental work. Here is a couple of them....

http://www.valvereplacement.com/forums/showthread.php?t=20936&highlight=antibiotics

http://www.valvereplacement.com/forums/showthread.php?t=20184&highlight=dentist

Personally, I'll take them until my Card (not my Dentist) actually tells me to stop.

 

[Bina]

I have been taking 600 mg of Clindamycine 1 hour before dental cleanings.

 

[Rich]

Al,
I will go with Wayne on that one, my cardiologist needs to make that decision.
What does a dentist know about heart valves ?
Personally I take 2000mg of amoxicillin (as a lot of our members do) before any cleaning or other invasive procedure, and I have been doing it for about eleven years.
I would much rather be safe than sorry.
Rich

 

[inventory]

Thank you wayne and rich.
I will ask my cardio but I do
agree with you at this point Rich.
If you have been doing it for 11
years I would never argue with
that. Yes, it is better to be
safe than sorry.
Thanks again.

 

[tobagotwo]

Prophylactic Antibiotics

Prophylactic Antibiotics

Over 50 years of data confirmed that our tried-and-true prophylactic antibiotics can't be shown to prevent anything.

There is no disagreement that some dental procedures can be linked with heart infections, although the statement now reflects that this could only account for an extremely small percentage of them. However, the evidence is also convincing that taking a bunch of antibiotic pills does not alter your chances of developing a cardiac infection one whit.

http://www.medicalnewstoday.com/medicalnews.php?newsid=69557 Some statements from it (bolding mine):

Contrary to long-held beliefs, the AHA's review of more than 50 years of scientific literature revealed that there is no definitive evidence that the prophylactic use of antibiotics prior to dental procedures prevents infective endocarditis (IE).

further, this study was done by

A group appointed by the AHA that included experts in infectious disease and cardiology and members representing the ADA developed the guideline.

The AHA statements about it: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.106.183095 Some excerpts (bolding mine):

The fundamental underlying principles that drove the
formulation of the AHA guidelines and the 9 previous AHA documents were that (1) IE is an uncommon but lifethreatening disease, and prevention is preferable to treatment of established infection; (2) certain underlying cardiac conditions predispose to IE; (3) bacteremia with organisms known to cause IE occurs commonly in association with invasive dental, GI, or GU tract procedures; (4) antimicrobial prophylaxis was proven to be effective for prevention of experimental IE in animals; and (5) antimicrobial prophylaxis
was thought to be effective in humans for prevention of IE associated with dental, GI, or GU tract procedures. The Committee believes that of these 5 underlying principles, the first 4 are valid and have not changed during the past 30 years. Numerous publications have questioned the validity of
the fifth principle and suggested revision of the guidelines, primarily for reasons as shown in Table 2.

and

TABLE 2. Primary Reasons for Revision of the IE Prophylaxis Guidelines

IE is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by a dental, GI tract, or GU tract procedure.

Prophylaxis may prevent an exceedingly small number of cases of IE, if any,
in individuals who undergo a dental, GI tract, or GU tract procedure.

The risk of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy.

Maintenance of optimal oral health and hygiene may reduce the incidence
of bacteremia from daily activities and is more important than prophylactic
antibiotics for a dental procedure to reduce the risk of IE.

Having said all that, they then fall back on saying that, even though there is no evidence that it prevents anything, they are going to continue to recommend it for those who've actually had a valve replaced and for a few other indicators, just in case it does help, even though they've shown that it doesn't. What a convoluted whitewash. It smacks of insurance companies and revisionist backpedalling by physicians who don't want to be completely embarrassed by having touted this manure to their patients as gospel for so many years.

Nonetheless, there is no three-year rule. If there were a time-based rule for valve replacement, it would be three months for standard valve replacement, and six months for any valve work that includes even partial replacement of the aorta. That's the amount of time it takes for reepithelialization (for the skin to grow back over it fully). This has been defined repeatedly as the period of greatest risk of endocarditis as well as stroke.

I do applaud your doctor's approach and agree with it personally, but I am not a medical professional. You must do what you believe is best for you.

Best wishes,

 

[Wise]

Al,
I will go with Wayne on that one, my cardiologist needs to make that decision.
What does a dentist know about heart valves ?
Personally I take 2000mg of amoxicillin (as a lot of our members do) before any cleaning or other invasive procedure, and I have been doing it for about eleven years.
I would much rather be safe than sorry.
Rich

It may fly in the face of sound science, but I'd also rather by safe than sorry.

 

[Blanche]

Al has a St Jude's mechanical valve because he got endocarditis from dental work. He will always be medicated for dental work forever....or until he becomes toothless!!!!
Blanche

 

[Bridgette]

What DO you do Bob?

What DO you do Bob?

Hi Bob

I am just wondering what you do - you seem to have all this medical knowledge at your fingertips...

Just for the record, my dentist will not do any fillings, cleaning procedures etc on me now without antibiotic cover.

Bridgette

 

[Ross]

Mine has stopped issuing antibiotics for filings and such, but continues for teeth cleaning and more invasive things.

 

[Adrienne]

My dentist, as well, says that for fillings it is not necessary. However, for cleaning, it is.

 

[Rich]

My current dentist is doing the same as Ross's.
I only pre-medicate for cleanings and invasive procedures.
One thing that did surprise me, was supposedly people who have had joint replacements such as hips, knees, etc, also need to pre-medicate according to a lot of dentists.
Rich

 

[WayneGM]

My dentist said some Cardiologists recommend taking antibiotics with any dental work while others recommend taking only when cleaning. He said he's not the expert so asked me what my Card recommends. Mine was in the "any dental work" camp last time I asked him. I'll ask again at my next visit. In the meantime, I'm going with the only recommendation I've gotten.

 

[susieq14]

I have not had surgery yet unlike all of you. At my 6 month cardio visit at the beginning of June, my cardio said I did not need any more antibiotics for dental work based on this new study. Not sure what my dentist will say. My next cleaning is in August. What if he says continue with them? Whose orders do you follow? Does it make a difference that my cardio thinks my valve was damaged from an infection that ran thru me (sinus, ear and UTI) within the month of January 04?

Ironically I just had a colonoscopy in December 06 and the GI didn't want to do antibiotics but the the cardio said yes they were needed not because of the colonoscopy but in case any biopsies were taken.

 

[tobagotwo]

You have to read what it says.

It doesn't say that dental work doesn't give anyone endocarditis.

It says that 50 years of evidence shows that the predental antibiotics we take don't prevent it.

Best wishes,

 

[Susan BAV]

Well-worded, as per usual Bob.

Here I am, personally opposed to taking any meds other than what I absolutely must take, and yet I want antibiotics before dental work. It really doesn't make a lot of sense, and evidently isn't quite a reasonable opinion, based on current studies...?

My cardio told me that I must take care of my teeth and gums though, for optimal survival and lifespan of my current valve. There are many ways of doing that. A few years ago, here on this site, we talked about some really positive study results connected to regular use of Listerine. I promptly went out and bought a huge jug of it from Costco and used it regularly. But it does something to my tastebuds and I didn't enjoy my food. So I quit using it. Perhaps it's time [for me] to get serious about taking care of teeth and gums again.

 

[RCB]

Always impressed.......

Always impressed.......

Over 50 years of data confirmed that our tried-and-true prophylactic antibiotics can't be shown to prevent anything.

There is no disagreement that some dental procedures can be linked with heart infections, although the statement now reflects that this could only account for an extremely small percentage of them. However, the evidence is also convincing that taking a bunch of antibiotic pills does not alter your chances of developing a cardiac infection one whit.

http://www.medicalnewstoday.com/medicalnews.php?newsid=69557 Some statements from it (bolding mine): further, this study was done by
The AHA statements about it: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.106.183095 Some excerpts (bolding mine): and Having said all that, they then fall back on saying that, even though there is no evidence that it prevents anything, they are going to continue to recommend it for those who've actually had a valve replaced and for a few other indicators, just in case it does help, even though they've shown that it doesn't. What a convoluted whitewash. It smacks of insurance companies and revisionist backpedalling by physicians who don't want to be completely embarrassed by having touted this manure to their patients as gospel for so many years.

Nonetheless, there is no three-year rule. If there were a time-based rule for valve replacement, it would be three months for standard valve replacement, and six months for any valve work that includes even partial replacement of the aorta. That's the amount of time it takes for reepithelialization (for the skin to grow back over it fully). This has been defined repeatedly as the period of greatest risk of endocarditis as well as stroke.

I do applaud your doctor's approach and agree with it personally, but I am not a medical professional. You must do what you believe is best for you.

Best wishes,

....with your patience, the expenditure of time and, ability to put your post in to a concise and coherent essay.

 

[WayneGM]

I just got this in the mail from my dentist....

For decades, the American and Canadian Heart and Dental Associations recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. Recent scientific evidence shows that for most people, the risks of taking preventative antibiotics outweigh the benefits.

Therefore, the good news is that most of these patients with Mitral Valve Prolapse and/or heart murmur no longer need short-term antibiotics as a preventative measure before their dental treatment.

The only patients who require antibiotics are those with:
1. Artificial heart valves
2. A history of infective endocarditis
3. Certain specific, serious congenital (present from birth) heart conditions including
? Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits;
? A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure;
? Any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or prosthetic device;
4. A Cardiac transplant that develops a problem in a heart valve.

The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs.

The full report is available to download, along with supporting charts, from the website of the American Dental Association at www.ada.org.

This is a major change for us. The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventative antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.

Scientists also found no compelling evidence that taking antibiotics prior to dental procedures prevents infective endocarditis in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests infective endocarditis is more likely to occur as a result of these everyday activities than from a dental procedure.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:
? Mitral valve prolapse;
? Rheumatic heart disease;
? Bicuspid valve disease;
? Calcified aortic stenosis;
? Congenital heart conditions such as ventricular septal depect, atrial septal defect and hyperthophic cardiomyopathy.

Please consult your medical doctor if you have any concerns.


....it was a form letter.

 

[Adrienne]

Well, since I had IE in 2004, I guess that means I am still on the list of people who should get antibiotics before dental cleaning. Oh well, I've never had problems with antibiotics, so I guess I guess it's worth it.

 

[RichC2000]

If I may throw in my two cents...

Last summer, I came down with a severe bout of infective endocarditis. It was, by far, the worst experience ever, and I can safely conclude that open heart surgery officially bites. If there is any protective factor at all, even if it's only an additional .0001% that I will not get this disease again because I took the antibiotics, then heck, give me the pills. In fact, my cardio prescribes 3 grams of antibiotics before and another 2 grams after my dental cleanings. True, swalloing a total of 10 pills is not very convenient, but then again, neither is a 6 week stay in the hospital, nor is a 6 hour heart valve repair procedure. If your dentists says you may not need antibiotics, double check on the facts and make sure you follow the guidelines. This comes from one who knows.