Dental Meds

[bvdr]

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

I remember that alcohol study and don't use alcohol before doing my INR but when I taught someone else to do it I included the step. Old habits die hard. There was a study too showing there wasn't a significant risk for diabetics to re-use syringes for a few times. I bet that hasn't flown either with the medical establishment. We are such creatures of habit aren't we!

 

[Blanche]

As many of you here know, Albert also got endocarditis from dental work in 1990. This caused problems with his valve and it was replaced. For many years he went to the the outpatient department of the local hospital for intravenous antibiotics and gentamicin.

Going to hospital everytime he needed dental work was quite a pain for him.
After his stroke, his internist offered to provide the medications in his office. He has two RNs in his practice and also two physicians' assistants. It works out quite comfortably for his office is less than a half mile from our home.

I have been told that another doctor here also provides that service for his patients.

Regards,
Blanche

 

[Adrienne]

Between the time I got endocarditis in 2004 (which I just got out of the blue, not because of any dental visit) I was told to have IV penicillin and gentamycin before my dental appointments. It was a real pain. I had to go to the hospital first, then go to the dentist. Now that I have had my surgery, I only take oral amoxillin.

What I find strange is the difference in the studies some members speak about and what Sue said her dentist said. Whom are we supposed to believe?!!

 

[Cooker]

I have no problem with antibiotics. I just take them and then head to the maniac with the drill

 

[sue943]

My dentist is going by the latest recomendations by the British Dental Association.

 

[Lynlw]

My dentist is going by the latest recomendations by the British Dental Association.

Did the old ones recomend IV's for anyone?

 

[Lynlw]

My dentist is going by the latest recomendations by the British Dental Association.

Sue, Do you have a link to a short list of their recomendations? One of theUK moms on a list I belong to had some questions, but the info she had is 118 pages http://www.nice.org.uk/nicemedia/pdf/PIEGuidelineConsulation.pdf

 

[fireftr]

I just asked my cardio the other day about this. He told me that antibiotics are not neccessary anymore and not to worry about it. I have yet to have an AVR but have BAV with moderate-severe regurg. It's hard when you read all of this conflicting information. It really reminds you why it's called the "practice of medicine". It really is pretty subjective.

Eric

 

[Philip]

Meds are inexpensive. Endocarditis sucks! I'll keep taking my meds; once was enough.
Philip

 

[lance]

Bobby Darin and endocarditis

Bobby Darin and endocarditis

Last night there was an autobiography on TV about Bobby Darin's life. He had rheumatic fever five times before the age of twelve and was considered "sickly" by his friends. He would leave the stage and immediately breathe oxygen from cylinders he carried with him. According to his son, Dod, Bobby neglected to take antibiotics as he usually did for his last dental appointment. No reason was given or known. Dod said his father developed endocarditis a short while later, was admitted to the hospital for surgery and died a few days later at the age of 37.

Food for thought regarding dental appointments.

 

[bvdr]

Sue, Do you have a link to a short list of their recomendations? One of theUK moms on a list I belong to had some questions, but the info she had is 118 pages http://www.nice.org.uk/nicemedia/pdf/PIEGuidelineConsulation.pdf

Lynn, that is a lot of information but I plan on reading it all when I get the time. On page 8 of the 108 pages there is a diagram concerning valvular heart disease. I read it as saying that antibiotics are not required for routine dental work but are for some intestinal invasive procedures and the like.

 

[sue943]

I just checked my copy of BNF and that recommends both oral amoxillin and intravenous gentamicin.

 

[cirrider]

Seems like the main question in this thread is: has anyone heard of a recommendation for intravenous gentamicin in the US? I, too, had endocarditis after dental work. The damage that it did to the mitral valve was the reason for the mechanical valve. My cardio continues to recommend oral antibiotics prior to dental work, but this is the first time I've heard of IV gentamicin. Since that is one of the "last resort" antibiotics, I would hate to create any resistant bacteria because of overuse. "Just my 2 cents worth".

Rob

 

[tobagotwo]

Some fodder for thought...

http://www.valvereplacement.com/forums/showthread.php?p=248361&highlight=association#post248361

Note: 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 prophylactic pre-dental-work antibiotics we take don't work to prevent it.

I would caution against using antibiotics when they're not specifically recommended.

It's to be remembered that antibiotics can be very hard on your body, particularly your digestion. Overuse of antibiotics has been linked to infections by less susceptible bacteria, some of which can be quite harmful. One such is helicobacter pylori (h. pylori), which has been linked to ulcers and GERD. Antibiotics can kill off colonies of beneficial bacteria (like the ones that help you to digest milk products), leaving open areas for the bad germs to colonize. This can create an unpleasant, damaging, and sometimes long-term situation in your intestines. At the very least, it can be worthwhile to take probiotics after a bout of antibiotic usage (with your doctor's approval, of course).

Note: While there is a great deal of disagreement in the medical community, the current AHA/ACC guideline agreement does still put all valve-problem patients in the risk pool that is recommended to take prophylactic antibiotics for dental and other physically intrusive work.

Best wishes.

 

[tobagotwo]

Not all dental procedures call for the use of prophylactic antibiotics. Some descriptions of when they would be used, if needed:

From the ADA website:

All patients in these high-risk categories may need antibiotics for all high-risk dental procedures. High-risk dental procedures are those involving bleeding or producing high levels of bacteria in your blood. They include:

all dental extractions
all periodontal procedures
dental implant placement or insertion of teeth that were knocked out
some root canal procedures
initial placement of orthodontic bands (not brackets)
certain specialized local anesthetic injections
regular dental cleanings (if bleeding is anticipated)

Another view of the guidelines of the American College of Cardiology, the American Heart Association, and the American Dental Association, in regard to when people using prophylactic antibiotics would use them for dental work...

Table 2. Dental Procedures and Endocarditis Prophylaxis

Endocarditis prophylaxis recommended*

Dental extractions
Periodontal procedures including surgery, scaling and root planing, probing, and recall maintenance
Dental implant placement and reimplantation of avulsed teeth
Endodontic (root canal) instrumentation or surgery only beyond the apex
Subgingival placement of antibiotic fibers or strips
Initial placement of orthodontic bands but not brackets
Intraligamentary local anesthetic injections
Prophylactic cleaning of teeth or implants where bleeding is anticipated


Endocarditis prophylaxis not recommended

Restorative dentistry? (operative and prosthodontic) with or without retraction cord?
Local anesthetic injections (nonintraligamentary)
Intracanal endodontic treatment; post placement and buildup
Placement of rubber dams
Postoperative suture removal
Placement of removable prosthodontic or orthodontic appliances
Taking of oral impressions
Fluoride treatments
Taking of oral radiographs
Orthodontic appliance adjustment
Shedding of primary teeth


*Prophylaxis is recommended for patients with high- and moderate-risk cardiac conditions.

? This includes restoration of decayed teeth (filling cavities) and replacement of missing teeth.

? Clinical judgment may indicate antibiotic use in selected circumstances that may create significant bleeding.

As you can see, filling cavities is in the Endocarditis Prophylaxis NOT Recommended column. Remember, the word "significant" is placed alongside bleeding in these recommendations.

Best wishes,

 

[dlangton]

flossing?

flossing?

I asked my dentist why I should take antibiotics just for a dental procedure that causes bleeding when ordinary flossing causes bleeding sometimes. His first answer was, "Hmmm." Later he told me that his opinion was that only those people who happen to have the bacteria in their mouths are at risk.

It's always nice to have a definitive answer, eh?

My wife is reading one of those alternative medicine books that says you absolutely should never have valve replacement surgery because the condition is curable with a natural treatment that is available only in Switzerland and Mexico and involves using something called a "dermatron" machine but is a little shy on details.

 

[Bryan B]

Well I was born in 1960 and have never seen a dentist for a procedure that may cause bleeding without premedicating in my entire life. I think this "preventative" medication is to cover dentists from getting sued if you contract endocardits after treatment. My endocarditis was caused by chronic bronchitis that "festered" and sent bacteria to my arotic valve and my prostate. BTW if you get chronic bacterial prostatitis your prostate may never be the same again. Don't ask me how I know that.

I was "lucky" that I had a picc line put in and was able to go home, go back to work, and function fairlly normally during my IV treatment. I gave myself the once a day dose of Rocephin (ceftriaxone) 2GM daily flushing with saline and heplock before and after. A home health nurse came by once a week to check my vitals, my picc line site, and change the protective dressing.

After that was done I found out I needed to have my aortic valve replaced and my VSD repaired. The infectious disease doc said that my VSD made me more vulnerable to bacteria entering my left ventricle and colonizing on my aortic valve.

Sooo...one of the several reasons I chose a Ross Procedure is that it significantly reduces the chance of contracting endocarditis compared to other prosthetic valves since you have your native pulmonary valve in the aortic position. And regardless of the current guidelines I will take antibiotics before any dental procedure that may cause bleeding or any other invasive procedure. I had my first colonoscopy about 9 months after surgery and they gave me IV gentamycin and IV clindamycin before the procedure. They also gave me some happy juice which was the most important IV I got. My tummy is pretty tough when it comes to antibiotics so taking a 2GM loading dose of amoxicillin 1hr before dental work and a 1GM dose 4hrs afterwards (that's what I took last time) is no biggie. The only side effect I've ever had from preventative penicillin or amoxicillin is the smell of it when you go to the bathroom.

Long post...short summary...I will follow my cardio's advice or my dentist's advice...whichever is most cautious. If both say I don't need antibiotics I guess I won't take them since I can't write my own prescription.

 

[catwoman]

My wife is reading one of those alternative medicine books that says you absolutely should never have valve replacement surgery because the condition is curable with a natural treatment that is available only in Switzerland and Mexico and involves using something called a "dermatron" machine but is a little shy on details.

I did some research and found this at Sloan-Kettering's website:

http://www.mskcc.org/mskcc/html/69136.cfm#ProfessionalPurportedUses

I'd be really leery about trying to "cure" a bad valve with a "natural" treatment.
After all, death is "natural," too.

 

[Sunshine susan]

Artificial Valve--take them

Artificial Valve--take them

According to both my cardio and my dentist, there has been new studies thatmany taking meds for dental work don't need to any longer.

However, this change does not apply to anyone with an artificial valve. I still have to take them.

 

[John & Joann]

Penicillin and gentamycin are administered by drip to Joann prior to any dental procedures that break the skin. She also takes the traditional medication by oral. Cleveland Clinic feels that this is MANDATORY for any high risk patients. If you develop an infection, you are in a serious problem. We will always follow Cleveland Clinic directives.

John & Joann
Still clicking since 1971