Dentist / Antibiotic question

[Pegasus]

Hi,
my husband broke a cap off his tooth. Does he need to take antibiotics for this?? They will likely fit a temporary cap and there shouldn't be any bleeding.
We will call the dentist later and ask but any thoughts are greatly appreciated!

He just had a dental cleaning 3 weeks ago (took Amoxicillin).

Also, a few weeks ago we both came down with fever and bad cough and my husband was put on antibiotics as endocarditits preventative. His GP wasn't there - another MD treated him. I thought this doesn't sound right since you can't treat antibiotics with a virus but we were too sick to 'fight'. He was put on antibiotics for bronchitis which he didn't have (as preventative). When his GP returned he said that was completely unnecessary. We don't want to over-use antibiotics as resitstance can build up quickly.

So, is it O.K. not to use antibiotics at the dentist if there is no bleeding?

Thank you for any input!
astrid

 

[Adrienne]

My dentist always tells me that to fill a cavity or change a filling I do NOT need antibiotics, so I presume it is the same with a cap. I suppose there is always the minute risk that the drill slips out of the dentist's hands and cuts into the gum!!

 

[Bradley White]

Well, yes and no. If there is no cutting (which means no bleeding) the chance of infection in the mouth is virtually zero and, thus, the chance of infection spreading to the heart is more or less non-existent.
However, dental work often produces unexpected cuts in the mouth. It is for this reason that even during standard cleaning prophylactic antibiotics are often prescribed. I understand your concern with the development of resistance, but if it was me I would take the antibiotics. However, other's opinions may differ.

Brad

 

[geebee]

The only reason he might need antibiotics is if they need to push back or cut the gum slightly to fit the crown on tightly. Can you tell I have lots of crowns?

He should ask the dentist. If it is merely recementing a new crown, he should not need antibiotics.

Yes, bleeding is the indicator of needing antibiotics. Bleeding can allow bacteria to make its way into the bloodstream.

 

[WayneGM]

My dentist asked me what my Card recommended as he said some Cards recommend taking antibiotics with any dental work while others recommend with only when cleaning. Mine happen to be in the "any dental work" camp.

 

[MaryC]

I recently had a crown put in and my dentist had me take the antibiotics prior to my appointment. I think it's more as a precaution, just in case some bleeding did occur.

 

[Superbob]

I guess we're all different but my doctors and dentists have insisted that I take antibiotics for any and all dental work, no matter how routine -- going back for years and years, before my heart surgery and now after it as well.

 

[Pegasus]

Thanks for the quick answers! You guys are great!!

Meanwhile, the dentist called and insisited on antibiotics. So, here we go again. I swear, in those 10 months post-op he has been on more antibiotics than all his life. We are still lucky though, there could be much worse problems...

Astrid

 

[tobagotwo]

Here, 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 Passage from the same source:

ADA Statement on Antibiotic Prophylaxis

The study, "Dental and Cardiac Risk Factors for Infective Endocarditis," appearing in the November 15, 1998 issue of the Annals of Internal Medicine, concludes that dental treatment does not seem to be a risk factor for infective endocarditis and that a reconsideration of the usage of antibiotic prophylaxis is in order.

However, the American Dental Association (ADA), like the American Heart Association, believes its current recommendations for endocarditis prophylaxis are valid and that modifications are not indicated at this time. Further research is warranted to determine whether some heart or valvular conditions would require coverage with pre-procedural antibiotics while others would be precluded.

The ADA's Council on Scientific Affairs believes additional knowledge is needed on the differences among various dental procedures. These include extractions, implant placement and some other surgical procedures to ensure that procedures associated with a higher risk of cardiac infection may continue to require antibiotic coverage for protection of at-risk patients against infective endocarditis. Likewise, further study is necessary before redefining some dental procedures as having low or no-risk of bacterial endocarditis.

The Council on Scientific Affairs will continue to monitor, analyze and assess research in the areas of endocarditis prophylaxis to ensure the safety and well being of its patients.

Citation: Journal of the American Dental Association 1998 Nov 15; 129(10): 761-9.

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. It can be worthwhile to take probiotics after a bout of antibiotic usage.

Here are the guidelines of the American College of Cardiology, the American Heart Association, and the American Dental Association, specifically for dental work, from last year. Quote from dental guidelines:

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. Everyone has brushed too hard or cut their gum on a potato chip at some point in time, and they certainly don't expect you to go back in time and take an antibiotic for that...

Best wishes,

 

[geebee]

Unfortunately, even with all the problems out there with antibiotic resistent bacteria and the toll they take on your body, doctors and dentists still give out antibiotics too freely.

I have had many crowns, fillings and even root canals down without antibiotics. The only time I had an endocarditis scare was after a tooth extraction which bled profusely and I had taken antibiotics for that so go figure. It turned out I did not have endocarditis anyway.

I am quickly leaning towards membership in the club that questions the usefullness of dental antibiotics at all.

 

[tobagotwo]

You 'n' me both, Gina. I find that study** the ADA is trying to ignore very comforting. They say that more study is needed, but the antibiotic regimen recommendation itself was not the result of any research. It just sounded like a good idea to some influential doctors. I've still been unable to find any studies at all that say that it does help lower the incidence of endocarditis in any general population.

As I've said before, I'll volunteer for the "no prophylactic antibiotics" group for any good study of it.

Maybe they'll eventually stop this antibiotic abuse. However, when they're on their high horses, like right now, they don't hear anything.

** "Dental and Cardiac Risk Factors for Infective Endocarditis," appearing in the November 15, 1998 issue of the Annals of Internal Medicine.

Best wishes,

 

[Pegasus]

Thanks, Bob, I printed this out so my husband can discuss this with the dentist tomorrow. He always takes probiotics for some time after antibiotic use so at least he doesn't have stomach problems.
astrid

 

[tobagotwo]

Unfortunately, the dentist can refuse to give service, if he doesn't feel that it's "in the best interest" of his patient. One of the things I didn't post was the statement of lawsuit possibilities that is on the ADA website. It summed up that the best thing for dentists to do is to use informed consent (the patient signs a contract stating what his/her choice is). However, the downside is that the dentist may have to prove that he fully informed the patient about the possible risks (which remain oddly unproven).

The lawsuit concern is really the sticker here (not meaning that most dentists don't want the best for their patients). They're always going to err on the side of what makes them feel safest, and what they may believe erroneously or correctly is the safest for their patients.

There probably are some categories of people for whom the prophylaxis may show to have a beneficial effect, but I personally believe it is a much more confined group than that for which is recommended now.

About a year before my surgery, I underwent complete periodontal (gum) surgery in two steps (one for each side). This has to be the most bacteremia-inducing surgery humanly possible. Each section of my mouth took about two weeks to heal completely, as I recall. And of course you eat with that healing mouth (amazing how sharp "soft" food can be on reconfigured gums), and still brush your teeth (I'll leave that to your imagination). Apart from my prophylactic doses on the dates of surgery, there was no antibiotic for those entire, ugly, swimming-in-mouth-bacteria healing periods.

When I asked, I was told they just don't give antibiotics for that. Does that make any sense? (No, I didn't get endocarditis.)

Best wishes,

 

[Pegasus]

Dentist read the print-out, still insisted on antibiotic. Cap was put - no bleeding (short procedure). At least dentist agreed to no antibiotics for fillings. Cardiologist actually said to take antibitoics for all dental procedures. I guess they are just very conservative. Hope that was the last round of antibiotics for a while.
Thanks.
astrid

 

[Ross]

Dentist read the print-out, still insisted on antibiotic. Cap was put - no bleeding (short procedure). At least dentist agreed to no antibiotics for fillings. Cardiologist actually said to take antibitoics for all dental procedures. I guess they are just very conservative. Hope that was the last round of antibiotics for a while.
Thanks.
astrid

There is some new guideline out from the ADA I guess. My dentist won't give antibiotics for anything except cleaning now.

 

[Susan BAV]

It hasn't been that long ago when we always had to take either 12 or 16 antibiotics for any dental procedure -- some of you others here will remember that. I think I had to take about 2/3 or 3/4 of them about an hour before the appointment, and then the remainder of them a few hours after the appointment.

But when I was a kid with a known heart condition, I had braces and several teeth filled and a few pulled and never was told to take antibiotics. So go figure. The medical trends often swing this way and then that way...

I'm usually opposed to taking any meds unless proven necessary. These, however, I think I'll keep taking before various dental procedures, at least while the jury's still out. Reminds me, I'm due for a dental cleaning!

 

[Adrienne]

I have a dentist appt. next Wednesday to change a filling. Although my dentist says it is not necessary to take the antibiotics, I think I am going to get some at the pharmacy anyhow and decide on Wednesday. I can always keep them for this summer (my next cleaning) since they usually last a year. I guess what scares me is that in 2004 my endocarditis which was caused by streptococchus virdans (sp?) which is bacteria from the mouth was not because of a dental appt. It just happened!! On the other hand, when I was first on Coumadin waiting for my operation, my gums in this one place where I used dental floss too agressively bled profusely, and nothing happened, so who knows - I'll just decide Wednesday.