I am studying endocarditis. There are studies and countries where antibiotic prophylaxis is no longer recommended before dental operations. The main advice is: "keep your mouth clean and free of plaque." I want to know if when I am cleaning my teeth and for some reason my gums bleed (without having gingivitis or some other infection) I can get endocarditis, or maybe if I bite my tongue while eating, or if I get a splinter in my gum. It is a very controversial topic.
Endocarditis from a drop of blood?
- Thread starter Wendel
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It is that! In the beginning of OHS for valve replacement(1960s-70s), my doctors or dentists never stressed any need for antibiotics before invasive dental work and I never took any. That meant I did not pre-medicate before dental work for the first 20-25 years.........with no problem. For the last 25+ years I have taken antibiotics(Amoxicillin) prior to any invasive dental work (cleaning, tooth removal, etc.), anything that causes bleeding and have had no problems. It may be a "coin flip" as to the need for pre-medication, but I think I will continue my Amoxicillin. I live by the old saying "If it ain't broke, don't fix it".
carolinemc
Well-known member
Hope you are going to reliable source, for not all studies are complete and outdated. And all countries use the antibiotics in infection protection and is very reliable in endocarditis prevention. Here where you can have this happen, no medication, have infection in the gums, get a cleaning and hours later you are rushed to the hospital and find you have endocarditis. That was from the infection of the gums. Happens a lot to unmedicated patients.
In the USA antibiotics before dental procedures is the standard for anyone with a mechanical heart valve. I think I've also seen this in information from England. I have not looked at other countries. There doesn't seem to be any good reason to not take antibiotics before dental procedures.
Since I have a mechanical aortic valve, I will also take amoxicillin before my cardiac ablation procedure next week.
Please remember that some of us had major damage from endocarditis before we got sick enough to rush to the hospital. DON'T FOOL AROUND with any risk of endocarditis!
In the UK, in the early 2000s they changed the guidelines to stop requiring antibiotics ahead of dental treatment. My cardiologist told me that there was a large rise in endo cases in his practice. This suggests that antibiotics do have a protective effect
The purpose of this thread was never to question antibiotics, in fact they are necessary. I want to know your opinions on how endocarditis is spread.
Conclusions
• The risk of IE after dental intervention is extremely low even in high-risk patients.
• The cumulative lifetime risk of IE from daily activities (chewing, tooth brushing, flossing) is much higher than that attributed to infrequent dental, respiratory, gastrointestinal, or genitourinary procedures.
• Antibiotic prophylaxis for IE in high-risk patients is a complex issue that remains unresolved, and there is broad consensus that there is little evidence from high-quality studies for or against its effectiveness and cost-benefit ratio.
• In America and most European countries, antibiotic prophylaxis is only recommended prior to invasive dental procedures in high-risk patients. However, in the United Kingdom and Japan, prophylaxis is not recommended even in high-risk patients, which is a true reflection of the existing uncertainty.
• Antibiotic prophylaxis for IE is a reasonable strategy for patients at high risk for IE or for serious adverse events with IE when undergoing high-risk dental procedures.
• Route antibiotic prophylaxis is not recommended for non-dental procedures. Antibiotic treatment is only necessary for patients at high risk for IE when performing non-dental invasive procedures in the setting of infection.
• Usually, neither the primary care physician nor the cardiologist or other specialist knows exactly what dental procedure their patient may need. Most prescriptions for antibiotic prophylaxis for IE are made by dental surgeons and dentists in the setting of defensive medicine. Education of these professionals and knowledge of clinical guidelines and patient-specific recommendations is paramount.
Mistakes to avoid
•Consider that any dental intervention carries a risk of IE.
•Consider that recommendations for or against antibiotic prophylaxis for IE come from high-quality studies and high evidence.
•Consider that all patients with cardiac pathology are high-risk patients for contracting IE.
•Do not convey to patients that the risk of contracting IE after any dental procedure, including those considered high-risk, is very low even in high-risk patients.
•Forget to take aseptic measures during the insertion and handling of venous catheters and during invasive procedures, including outpatient procedures, to reduce the rate of IE associated with diagnostic and therapeutic procedures.
Link to the article in Spanish (translate)
https://www.fmc.es/es-profilaxis-antibiotica-endocarditis-infecciosa-articulo-S1134207219300969
I have read quite a few, but this one seems very complete to me.
Conclusions
• The risk of IE after dental intervention is extremely low even in high-risk patients.
• The cumulative lifetime risk of IE from daily activities (chewing, tooth brushing, flossing) is much higher than that attributed to infrequent dental, respiratory, gastrointestinal, or genitourinary procedures.
• Antibiotic prophylaxis for IE in high-risk patients is a complex issue that remains unresolved, and there is broad consensus that there is little evidence from high-quality studies for or against its effectiveness and cost-benefit ratio.
• In America and most European countries, antibiotic prophylaxis is only recommended prior to invasive dental procedures in high-risk patients. However, in the United Kingdom and Japan, prophylaxis is not recommended even in high-risk patients, which is a true reflection of the existing uncertainty.
• Antibiotic prophylaxis for IE is a reasonable strategy for patients at high risk for IE or for serious adverse events with IE when undergoing high-risk dental procedures.
• Route antibiotic prophylaxis is not recommended for non-dental procedures. Antibiotic treatment is only necessary for patients at high risk for IE when performing non-dental invasive procedures in the setting of infection.
• Usually, neither the primary care physician nor the cardiologist or other specialist knows exactly what dental procedure their patient may need. Most prescriptions for antibiotic prophylaxis for IE are made by dental surgeons and dentists in the setting of defensive medicine. Education of these professionals and knowledge of clinical guidelines and patient-specific recommendations is paramount.
Mistakes to avoid
•Consider that any dental intervention carries a risk of IE.
•Consider that recommendations for or against antibiotic prophylaxis for IE come from high-quality studies and high evidence.
•Consider that all patients with cardiac pathology are high-risk patients for contracting IE.
•Do not convey to patients that the risk of contracting IE after any dental procedure, including those considered high-risk, is very low even in high-risk patients.
•Forget to take aseptic measures during the insertion and handling of venous catheters and during invasive procedures, including outpatient procedures, to reduce the rate of IE associated with diagnostic and therapeutic procedures.
Link to the article in Spanish (translate)
https://www.fmc.es/es-profilaxis-antibiotica-endocarditis-infecciosa-articulo-S1134207219300969
I have read quite a few, but this one seems very complete to me.
They have told me to take 2g amoxicillin for my cardiac ablation next Wednesday. They have not told me what time to take it; for dental procedures I've been told to take it 1 hour before the procedure. They also have not said anything about washing with special antibiotic soap like I did before my open heart surgery. Perhaps they just do a local wash in the groin area where the catheters will be inserted.
A nurse from the surgery team will talk with me Monday, so I will get these questions answered then.
I’m not sure this statement is correct regarding high-risk UK patients.
I was specifically told by my cardiologist on my 2 month post valve replacement surgery follow-up, to make sure I always took antibiotics for any invasive dental procedure.
At a cardiology review in May 2023 following a visit to A&E because of fever and increased BP and heart rate (and thus possible endocarditis), I was again advised to take an “…antibiotic prophylaxis for any blood eliciting dental procedures...”
The Cardiology Department issued me with a wallet advice card to show doctors or dentists prior to any invasive procedures.
Just today I was reading about endocarditis. I had Golden staph(Aureus staphylococcus) from 2018 till now 2 times in one year till now. I now I have critic aortic stenosis. Now, I am pretty sure that Golden staph entered my bloodstream through 4,5 years and eat my aortic cuspises...My theory....Just my instinct tell me that
pellicle
Professional Dingbat, Guru and Merkintologist
that's not unreasonable. Another culprit for causing aortic valve damage is "Scarlet Fever" ... as it happens our most elder member (@dick0236 ) had his valve damaged by Scarlet Fever and was replaced decades back with a mechanical.
Dicks "about"
Aortic Valve Stenosis diagnosed in early teens as the probable result of scarlet fever (or rheumatic fever?) in childhood although my mother said I was "born with heart murmur". Some physicians now feel I may have had both scarlet/rheumatic fever and a bicuspid valve.
Surgical intervention was not available until the 1960s and I had surgery with aortic valve replacement(1967).
family( wife, 2 sons/wives, 3 grandkids,6 great-grandkids)
SurgeryAortic
valve replacement at age 31(Starr-Edwards mechanical "caged ball" valve) Aug. 1967. His original Starr-Edwards valve is still functioning normally and is believed to be the longest operating valve in history.
Which is why I've been saying to you "examine valve choice very carefully".
I will put it a bit further and say "if you don't pick a mechanical you're a Mug".
Warfarin therapy is not difficult to manage. I can guide you through it, but the hardest part is navigating the morons who are the clinicians ... no, really.
Best wishes
My mitral valve was damaged by rheumatic fever (strep)
carolinemc
Well-known member
The bacteria in your mouth, or cold, can travel through the blood stream directly into the heart. Thus the infection of the heart begins.
I know, but the causes and cure for this disease, which has been around for more than 50 years, are still not 100% known. In fact, everyone "eats" bacteria constantly. I think this has to do with the immune system + oral and skin hygiene + prosthetic valve. If you have a strong immune system and good oral and skin hygiene, you should not have endocarditis.
I am talking about the skin because the two main bacteria that cause it are in the mouth and on the skin. It is not a common disease, in fact many people with prosthetic valves never have it in their lives. We cannot predict the future, so the best thing is to follow the instructions and avoid complications, and in the case of contracting it, your medical team must act as soon as possible to reduce complications.
Thank you for your posting, i just read the article in Spanish, attached pdf, and in there says to check table 5 for procedures that need the 2g of antibiotics, and is clear that people at high risk of IE like all with foreing objects in their hearts are in the high risk group, so., in spanish that is what it says'. who knows what Google translate sales as translation
google always wants something .... 
Gail in Ca
Well-known member
I am a person who takes care of myself with daily bathing, teeth brushing and flossing and I rarely get sick. But, the bacteria that entered my bloodstream wanted to kill me. It was acute endocarditis. I had no wounds, no dental issues. It came on fast and a week after my first symptoms of severe aches and right shoulder pain, I had gotten a subarachnoid hemorrhage and was going into DIC. The lab results said Staph. Lugdunensis, a rare, nasty bacteria that lives on the skin and in the nose. It took 2 hospital stays to find the right antibiotics to kill it and 6 weeks of 23 hr a day treatment at home with a PICC line.
A month after treatment, I needed my 3rd surgery to replace what that bacteria had done to my valves and graft.
So, you never know….
A month after treatment, I needed my 3rd surgery to replace what that bacteria had done to my valves and graft.
So, you never know….
Did you have Disseminated intravascular coagulation? That is VERY scary.
I had endocarditis 2 years ago; it damaged my mitral valve and destroyed my aortic valve. My endocarditis was from Staphylococcus Epi, which is common on most everyone's skin. We can only guess how the Staphylococcus Epi got inside my body.
The infectious disease Doctors suspect it may have been dormant inside me for a long time. On the other hand, I had a cortisone injection in my left knee (for severe arthritis) just a few weeks before the endocarditis, so perhaps it came from that procedure.
1 week after the cortisone injection my knee became very painful and swollen. I also became extremely fatigued. Perhaps the Staphylococcus Epi was building a base in my knee before the infection moved into my heart.
Gail in Ca
Well-known member
After all was over, my cardiologist thought I was going into DIC when I was in ER.
Luckily, the vitamin K shots stopped my INR from its trend of going up (it was at 9 when I got to the ER). My nurse friend said they say DIC means death is coming!
I think we are all pretty lucky to survive endocarditis because it doesn’t seem to be diagnosed in a timely manner, even when the doc knows we have prosthetic valves.
Luckily, the vitamin K shots stopped my INR from its trend of going up (it was at 9 when I got to the ER). My nurse friend said they say DIC means death is coming!
I think we are all pretty lucky to survive endocarditis because it doesn’t seem to be diagnosed in a timely manner, even when the doc knows we have prosthetic valves.
