mitral valve repair and dental work

[deano89]

hello again long time away , 9 years ago had a mitral valve repair with st jude ring , i was told by cardiologist to have antibiotics 3g amoxicillin before dental treatment , my main dentist at present says its my choice but she couldnt treat me for an emergency extraction for infected tooth
,the trouble im having is this Dentists seem reluctant to give me these antibiotics he quote NICE and say its not proven that it prevents IE etc etc but had this trouble with other dentists as well thats why i travel further to the one that doesnt give me hassle ,
long story short i had one satchet spare so took this before extraction , after extracction part of root was was left behind and he put me on 7 day course of amoxicillin for the tooth infection next day had to go to a specialist to have rest of root removed i said about the 3g amoxcillin and he said i didnt need it because i was on 7 day course and had 3g day before i disagreed but he wasnt shifting so had root removed and the root remover Dentist said take 2 of the 500g i was on when i get home which i did , this all seems a mess to me , question
1/ was this correct , before and after the removal i had 3g before approx 12.45pm then i took first of course 500g last thing at night then 1 on the morning of the root removal approx 3-4 hours before , then 2 when i got back home approx 1/2 hour post root removal? question 2 / did they or am i ( this was only finished last saturday ) put at risk by refusing the 2nd 3g for the remainder of the root to be removed or was the fact i was on a 7 day course of 500g sufficient protection

sorry for the ramble hope its clear how do i get dentist to be consistent and give me the prophylaxis 3g?

 

[Zoltania]

The recommendations for antibiotics tend to change over time. Can you go back to your cardiologist and get his/her opinion? The dentist should be likely to accept that decision. You should be able to get any needed antibiotics from your cardiologist or primary physician.

For what it's worth, my cardiologist said I do NOT need antibiotics for routine dental cleanings. I'm sure treatment of an infection, or more invasive dental (or other) procedures, would be different, though.

 

[pellicle]

I live in Australia and my dentist is full on about this.

• will have his staff ring me the day before any clean to remind me (and ask if I need a script)
• will ask when I arrive in the waiting
• will ask again when I'm in the chair

to be honest (as a microbiology trained guy) I disagree with the NICE guidelines in this topic, as to me they put some nebulous issue on antibiotic resistance over human health.

I'd insist ... but then I'm risk averse (says the guy who rides motorbikes)

 

[Homeskillet]

Correct me if I am wrong, but I thought the prophylactic protocol was 2,000 mg (or g?) 1 hour before dental procedures?

There’s absolutely no way I would not have prophylactic care before cleanings. I have them every 4 months & always take 2,000 mg of amoxicillin.

I had had an endoscopy done about 10 days ago & even the GI people insisted that I take them prior to the procedure (I did develop a GI bleed due to the lovenox though :confused2.

 

[pellicle]

Hi

Correct me if I am wrong, but I thought the prophylactic protocol was 2,000 mg (or g?) 1 hour before dental procedures?

I understand it varies, there is no evidence backing up the dose, it's just "seat of the pants".

In Australian it was 3 now it's 2...

(I did develop a GI bleed due to the lovenox though :confused2.

Seems to suggest that the less aggressive return to AC therapy that is suggested by the Australian groups is bourne out by that experience (as well as the thousands of cases examined supporting the research) too.

I hope it wasn't serious and was contained quickly.

 

[Paleowoman]

sorry for the ramble hope its clear how do i get dentist to be consistent and give me the prophylaxis 3g?

deano89 Hi - NICE guidance now does not recommend antibiotic prophylaxis before dental work so dentists like to stick with that advice. However, NICE guidance is just that: guidance, it is not a rule. If you can get a letter from your cardiologist stating that you do need antibiotic prophylaxsis before invasive dental work that you can show dentists they really should abide by that. I have a copy letter I can take with me and that works - not for cleaning though unless it is one of those 'deep cleans'. (I'm allergic to penicillin so I am given azithromycin instead).

 

[deano89]

thanks for the replies , i believe cardios now give a letter ,but that was long after i was discharged to community care by local doctor ,his view was they should be more worried about being sued , not sure if the cardio is still at my hospital but will write as she did make it clear i was to have them , think the confusion comes with the constant changing of NICE guidelines still worried that i was left high and dry this time with the final root part removal

 

[Agian]

Better to be safe than sorry. The NICE guidelines... yeah whatever. A bunch of tossers sit around the table and waffle on about antibiotic resistance. They're not the ones risking endocarditis.

 

[tom in MO]

My cardio handles this not my dentist. The US guidance says antibiot before tooth cleaning but not cavity filling. My cardio is more conservative and wants antibiot before any dental work. He says his opinion is based upon personal experience...he's old too From what I read, the metric for antibiotics is whether or not there the surface of the gums will be broken (e.g. blood.)

 

[deano89]

thats what i was told anything around the gum line is the problem even brushing teeth can cause a problem , when i said to this dentist i want antibiotic cover he looked and responded like i was asking him to give me illegal drugs ....im really pi**ed off with it , they would put me at risk for the sake of a sachet of amox doesn't figure, i sure if it was them they would soon get the pad out ! as you say alright for the to**ers from NICE to sit round second guessing whether it works or not, i would rather be on the side of caution! wish i could of said no but the root had to be removed before bone grew over it ! seems like im the only one having this issue with dangerous dentists article below i found

https://bjgpopen.org/content/bjgpoa/1/1/BJGP-2017-0593.full.pdf

 

[pellicle]

when i said to this dentist i want antibiotic cover he looked and responded like i was asking him to give me illegal drugs ....im really pi**ed off with it

worth reading this ...
http://www.valvereplacement.org/for...n-after-valve-replacement?p=868462#post868462

 

[Homeskillet]

Hi



I understand it varies, there is no evidence backing up the dose, it's just "seat of the pants".

In Australian it was 3 now it's 2...





Seems to suggest that the less aggressive return to AC therapy that is suggested by the Australian groups is bourne out by that experience (as well as the thousands of cases examined supporting the research) too.

I hope it wasn't serious and was contained quickly.

Yea’, that worry was in the back of my mind, but, I figured they could replace blood cells quicker than they could brain cells (as someone smart once told me ).

Lesson learned the hard way, next time I will wait longer than 3 hours to resume AC therapy.

First I ever read about 3,000 mg. being a protocol for prophylactic protection. Think i’ll play it safe and use 3,000 at my next cleaning.

Good thread.

 

[Homeskillet]

Incidentally, all of my surgeons & cardios (& trust me, I have had many over the last 3 years) have strongly indicated that under NO circumstances am I to have dental work without prophylactic protection of at least 2,000 mg. of amoxicillin 1 hour beforehand.

just sayin.

 

[MartinF]

My cardiologist gave me my prescription for Amoxicillin, 2,000 mg (four 500 mg capsules) to take 1 hour before dental appointment. He gave me 12 refills so I usually get a refill to keep around the house in case of emergency.

 

[deano89]

pellicle thanks , thats an interesting read , NICE does seem to be LAW in UK dentists head all having there own interpretation and ignoring me as a high risk patient ! , ignoring the facts that high risk patients should have cover , even at my Dentist who does prescribe and understands the guidelines ,when she was off i had another dentist i same practice , told her i have cover for dental work she gave me the 3rd degree and asked for proof etc etc eventually i just said i give you permission to write to my cardiologist and access my records , when my regular dentist returned she put her straight and never had a problem after that until this time same Sh*t different practice NICE just confuses everthing and some Dentists are just more scared of prescribing than possibly killing someone , i have sent a letter off today to the cardiologist to see if i can get some sort of letter to save all this , just adding up today all in all i have had only one dentist out of five that i havent had problems with and had to argue to get this cover ! just seen the date and its 9 years today that i was on the table at this very time having the repair b.....how time flys

 

[Paleowoman]

deano89 Another option is to get your GP to prescribe the antibiotics for you since it is a cardiac issue you are getting the antibiotics for. When I got a letter from the cardiac surgeon and, as well, my cardiologist, saying I should have antibiotic cover for invasive dental work, I gave copies of those letters to my GP. Since then Azithromycin for dental antibitoic prophylaxis, is on my repeat prescription.

Re NICE I once wrote to my MP about another medication and NICE guidance, asking whether it was "law". The MP wrote to the Secretary of State for health who replied by letter that it was only guidance and not law !

 

[deano89]

did speak to doctor about the situation and he just said they should be prescribing and that they should be more worried about being sued than issuing a prescription there guidelines and its absolutely clear i should have them , will see how it goes with cardio letter then see my GP and ask directly if he will prescribe on repeat , get the feeling he thinks there bang out of order there doing the work and need to get there act together as its there responsibility to issue it

 

[Paleowoman]

did speak to doctor about the situation and he just said they should be prescribing and that they should be more worried about being sued than issuing a prescription there guidelines and its absolutely clear i should have them , will see how it goes with cardio letter then see my GP and ask directly if he will prescribe on repeat , get the feeling he thinks there bang out of order there doing the work and need to get there act together as its there responsibility to issue it

Woa - your GP should surely be more concerned about your health than who should be issuing the prescription ! It's no skin off the GP's back if he/she issues the prescription rather than the dentist ! Usually, too, when a GP issues a prescription it's all done via a computer and printer whereas a dentist usually still has to handwrite prescriptions LOL Goodness, you have come in contact with some pretty carp dentists and GPs who care more about NICE and who should be giving you a prescription than your health !

 

[deano89]

will have to ask my doctor out right only ever really asked his advice on the subject of NICE etc always treated it as the dentist thats responsible so never considered asking doctor, hopefully get a response from cardio soon , i always thought the Dentist should just do it but for some resaon NICE seems to have them scared to get there pen out ! but repeat would save explianing everytime i get a new dentist and mke my life a lot less stressful ,
there was more on news today about antibiotic resistant bugs so guess its going to get even harder :-(

 

[deano89]

got a letter back today from my cardio so i can now hopefully avoid anymore awkward dentists refusing to prescribe antibiotics under NICE guidelines
also cardio sent copy to my GP