Dental Meds

[starfish11040]

I'm in a bit of a quandary. My cardiologist told me not to take the prophylactic antibiotic. My dentist has always been a stickler about, always confirming with me that I took the antibiotic before any dental work, even minor. So i called him to notify him what my cardiologist said. His receptionist said that I must bring a note from my cardioligist. I then made that request to my cardiolist's office. What i got in the mail was not a note but a copy of a page with the new AHA guidelines with the words "show this to your dentist". I then personally went to the office and told the receptionist that I need a real note. The doctor wasn't in but she said she'll tell him the next day and fax it. Well, late the next day she called me and repeated that the AHA guidelines is sufficient.

It seems to me that both of these guys are trying to legally cover themselves. The cardiologist does not want to put his recommendation in writing, and the dentist does not want to go ahead unless it is.

My cleaning is tomorrow. Looks like I'll have to take the antibiotics this time even though according to the AHA I don't need to. I'll talk to the dentist in person about it tomorrow, and to the cardio at my next appointment. One of them is gonna have to give.

 

[WayneGM]

When I had my last check-up with my Cardio he confirmed that I no longer need to take antibiotics before dental work. I went for my cleaning yesterday and didn't take them. My Dentist was already aware of the new guidelines and his position was to be guided by your medical doctor or cardiologist (as per the form letter I posted earlier). He didn't require a note and just adjusted my file to reflect I no longer needed them after I told him what the Cardio said.

 

[lance]

Wow, much discussion

Wow, much discussion

Don't confuse me with the facts, my minds made up. It's antibiotics for me.

 

[Bina]

I was just at the dentist for a cleaning on Friday where the receptionist, hygienist, and dentist all asked me if I had taken my antibiotics. Dentist said it was in my favour to take them and not risk any problems for my nice, new valve. I agree. I needed another visit, for a small filling, so he is having me wait for 6 weeks so that I don't overload my system with antbiotics.

 

[DeWayne]

I have been taking antibiotics before any surgical procedure including teeth cleaning etc since I was a child. Big difference today is 4 pills an hour before compared to when i was younger. When I was younger I used to have to take stuff for 10 days prior to any procedure and 10 days after.

So to take 4 pills an hour prior now is just no big deal.

 

[Blanche]

Our dentist requires antibiotics and our cardiologist insists on them for Albert. As mentioned before, Al has a mechanical valve today because he did not medicate before dental work and he got endocarditis.

Al will be medicated before dental work forever or until he becomes toothless.

Blanche

 

[Marty]

Our dentist requires antibiotics and our cardiologist insists on them for Albert. As mentioned before, Al has a mechanical valve today because he did not medicate before dental work and he got endocarditis.

Al will be medicated before dental work forever or until he becomes toothless.

Blanche, Im not being facetious but Al should also be medicated before he brushes his teeth or bites into a steak. It has been shown that both of these activities result in a "shower" of bacteria into the blood stream. Its also very difficult to ascertain why some people get endocarditis after dental work (or brushing).For the majority of endocarditis patients there is no explanation.My dentist never prescribed prophylaxis for me and I so far have not gotten endocarditis.He said he reviewed the literature and there is no evidence that antibiotic prophylaxis reduces the risk of endocarditis and that lack of antibiotics increases the risk.(Years ago they did a similar study at Mayo that showed wiping with alcohol before vein stick did no good-or harm. They still do it).Same thing will be true at least for us with mechanical valves unless you have an ornery dentist like mine. Marty

 

[Blanche]

Marty:

You know I loves ya more than a piggy loves mud. I appreciate your insight on this.

The toothless option is looking better and better all the time.

Regards,
Blanche

 

[Debster]

My mom's cardio said to make sure she takes her meds before cleaning ALWAYS!!! Deb

 

[maestrorn]

premed for dentist work

premed for dentist work

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.

As an ICU nurse, i want to share something that struck a deep nerve with me this past week. I work in a medical ICU and cared for a patient that had developed bacterial endocarditis a month after having dental work. She had developed vegetation on both the mitral and aortic valve so severe that it was now fatal. When the cardiologists came in to do an echo, I asked them if the patient would've had to have some preexisting condition for this to happen. They informed me that 50-60% of these cases happen to patients who have no preexisting valve conditions, just bad luck. Coincidently, I had my dental exam two days later which was already scheduled when I was caring for this patient. Yes, I took the clindamycin even though it tore my guts up for 2 days. But it's a price I am very willing to pay and I encourage you to do it as well. It was miserable seeing the family members and that patient suffer.

 

[Lisa in Katy]

I was one of those who took antibiotics for several years after RF. Then they told me to stop. I guess because I took them routinely anyway, I was never told I needed them particularly for dental work. At some point I went to a dentist who figured out I was no longer on antibiotics and he refused to clean my teeth without them. That's the first time I knew I needed them. After surgery I was told to continue taking them for all dental work.

What I have always wondered is why. I had bacterial endocarditis with RF, caused from strep, so I know about the risk of endocarditis. My question is why is the risk considered worse with dental cleaning than when you get a popcorn hull stuck in your gum or have a mouth ulcer? My gums bleed routinely with tooth brushing and did long before I ever had RF, so I'm not sure the reasons for antibiotics strictly with dental cleaning are accurate in my case. Interestingly enough, having to take antibiotics causes me not to want to have my teeth cleaned, even though it's important, because it throws off my INR!

 

[Bina]

I had my teeth cleaned a week ago.....most antibiotics make me sick, so I took Clindamycin.....no problem at all. INR was just fine (I home test).

 

[lance]

Dental antibiotics

Dental antibiotics

I've been taking Cephalexin for every dental appointment for years (lots) and have never noticed a correlation to my INR up or down. Maybe testing once a week is the answer.

 

[francie12]

While I do accept that the evidence shows that pre-dental antibiotics are ineffective and unecessary, I'm having trouble with the logic of why this is so. Seems like when you have your teeth cleaned you get an exceptionally large amount of bacteria loosed into your bloodstream all at once (particularly if you are a teenager who is iffy about flossing even though your mom is on your back about it!), and if antibotics are in the blood stream at the same time, carried to the same places, wouldn't it be the case that there could be some greater protection against an infection lodging someplace like a heart valve?

I guess like many things it just seems like it ought to work, even if it does not, and is hard to let go of for that reason.

For the record, I had my son take them one last time before his cleaning last week, because his gums were not the best from missing flossing. But next time I think we'll skip it...but I can't help the qualms...

 

[ALCapshaw2]

I also received a copy of the New AHA Guidelines at my last Dental Cleaning. Since I have an artificial valve, I expect my Dentist and Cardio will agree to continue prophylactic antibiotics.

I have always wondered though, about anti-biotics before FLOSSING.

After all, you are presumably releasing bacteria from that process, and OFTEN have Bleeding because of too much pressure, especially if you have Tight Teeth. That issue always seemed to be ignored... BUT, NO ONE wants to be taking anti-biotics EVERY TIME they FLOSS!

No wonder it's so difficult to write clear and correct standards.

'AL Capshaw'

 

[Mb]

Hello!

I thought I would chime in on this one.

My husband had his second heart valve surgery this year, in Feburary. He currently sports two St. Jude mechanical valves, and one tricuspid annuloplasty ring. At our last visit to the cardiac surgeon, Dr. Gus vlahakes at Mass General, he was emphatic about taking the antibiotics. He said aside from taking his regular medications, premedicating for dental procedures was a must. He advocated 4000 units of the anitbiotic prior to any procedure. He was extremely firm about it, regardless of what any other cardio or dentist might recommend. And, obviously, that is what he takes.

Why would anyone flirt with the recommendations?


Marybeth

 

[VikiVix]

meds

meds

I would stick to what your cardiologists say. I had aortic valve replacement in December and they told me to take antibiotics before any dental work.
Viki

 

[sue943]

Rather than start yet another dental meds thread I will tack it on here...

Today I went to the dentist for my six-monthly check and he told me the guidelines have changed since he last saw me. Last time I had to have 3 grams of Amoxillin an hour before my cleaning or any other treatment such as fillings - the straight examination was ok without any. Today he says that the new recommendations are that for cleaning not only should I have the Amoxillin but also intravenous gentamicin. Therefore he is writing to the dental department of our local hospital, and presumably the cardiologist, for instruction and to see if they will do the cleaning for me in hospital as the dentist cannot administer intravenous drugs such as this.

So it looks as if the guidelines are getting more cautious. I have great respect for this dentist, he wants to do things by the book and not put me at risk. He also mentioned that I HAD been his only endocarditis patient but recently he saw a man who had also had it.

 

[Susan BAV]

Rather than start yet another dental meds thread I will tack it on here...

Today I went to the dentist for my six-monthly check and he told me the guidelines have changed since he last saw me. Last time I had to have 3 grams of Amoxillin an hour before my cleaning or any other treatment such as fillings - the straight examination was ok without any. Today he says that the new recommendations are that for cleaning not only should I have the Amoxillin but also intravenous gentamicin. Therefore he is writing to the dental department of our local hospital, and presumably the cardiologist, for instruction and to see if they will do the cleaning for me in hospital as the dentist cannot administer intravenous drugs such as this.

So it looks as if the guidelines are getting more cautious. I have great respect for this dentist, he wants to do things by the book and not put me at risk. He also mentioned that I HAD been his only endocarditis patient but recently he saw a man who had also had it.

Very interesting, Sue. Thanks for that.

Has anyone on this side of the pond heard or been told anything new along this line?

 

[Lynlw]

Very interesting, Sue. Thanks for that.

Has anyone on this side of the pond heard or been told anything new along this line?

After Justin's BE, 8 years ago, we were told that usually people that have BE need IV antibiotics for dental, but Justin didn't,(I can't remeber why he didn't maybe because no vegitation?) So I'm wonderring where Sue lives just changed their guidelines?