No teeth cleaning or elective dental procedures for a year after surgery??

[mikeccolella]

So many people on this forum claim a 6 month wait for dental work after heart valve surgery. The AHA guidelines NEVER Say this. They only say pre med 2 gms amoxicillin. So much misinformation on this site.

 

[cldlhd]

Well as with a lot of things there are varying opinions. It might not be in the AHA but I was told by my surgeon to wait 6 months, I waited 8, so that everything would be fully healed. Made sense to me and as it was only a cleaning no real need to rush in sooner. He also recommended antibiotics an hour prior.

 

[pellicle]

So many people on this forum claim a 6 month wait for dental work after heart valve surgery. The AHA guidelines NEVER Say this. They only say pre med 2 gms amoxicillin. So much misinformation on this site.

while spreading mis-information would you like to clarify your claims? Both the claims of 6 months wait being "so many people" and where the AHA guidelines NEVER say this please?

I've not found specific mention of duration of delay after surgery, this is about the most clear I've found.

http://www.aafp.org/afp/2008/0215/p538.html

PATIENTS UNDERGOING CARDIAC SURGERY


A dental examination before cardiac surgery is recommended so that dental treatment can be completed before the procedure. Patients who undergo surgery for prosthetic heart valves or intravascular or intracardiac materials are at risk of infection. Because morbidity and mortality associated with these infections are high, perioperative antibiotic prophylaxis is recommended.

Early-onset prosthetic valve endocarditis is most often caused by S. aureus, coagulasenegative staphylococci, or diphtheroids. No antibiotic regimen is effective against all of these microorganisms. Antibiotic prophylaxis at the time of surgery should be against staphylococci and should be of short duration. A first-generation cephalosporin is typically used; however, antibiotic choice should take into account the antibiotic susceptibility patterns of the patient's hospital. Most nosocomial coagulase-negative staphylococci are methicillin resistant. Even so, antibiotic prophylaxis with a first-generation cephalosporin is recommended for these patients.

It fails to discuss times. I agree that 6 months is later than I've often heard. Normally 3 months is mentioned. I agree that within the various medical communities there is no uniform agreement.

However, as always I suggest you clarify this with your surgeon. Not just a bunch of folks on the web.

I always tell people that you should verify everything you read, only a fool would simple accept spoon feeding by an internet forum as being "the word".

I hope you will list some of the other "so much misinformation on this site" for clarification (or is this the only point you have found).

 

[mikeccolella]

while spreading mis-information would you like to clarify your claims? Both the claims of 6 months wait being "so many people" and where the AHA guidelines NEVER say this please?

I've not found specific mention of duration of delay after surgery, this is about the most clear I've found.

http://www.aafp.org/afp/2008/0215/p538.html



It fails to discuss times. I agree that 6 months is later than I've often heard. Normally 3 months is mentioned. I agree that within the various medical communities there is no uniform agreement.

However, as always I suggest you clarify this with your surgeon. Not just a bunch of folks on the web.

I always tell people that you should verify everything you read, only a fool would simple accept spoon feeding by an internet forum as being "the word".

I hope you will list some of the other "so much misinformation on this site" for clarification (or is this the only point you have found).

First of all the mis-information is right here in this thread. If doctors are recommending the 6 month wait it is NOT based on AHA guidelines. If someone had a serious dental problem they might not give it attention based on the information in this thread. As for myself I did ask both my cardiologist and my surgeon. The surgeon said wait three months. My cardiologist said it does not matter just so long as you pre-med. The cardiologist is correct based on the exhaustive AHA research and resulting guidelines. So trust me I am not " a fool" , however I think as a member of this very serious forum we should challenge misinformation when it is posted repeatedly.

 

[pellicle]

First of all the mis-information is right here in this thread.

well given the proportion of information that this thread makes of the entirety of this site I would hardly say that it makes the whole barrel rotten ...

... however I think as a member of this very serious forum we should challenge misinformation when it is posted repeatedly.

I agree, and you will find many of my posts where I challenge "assertions" which are unsupported. I usually support my views with citations to back them up (or provide them where asked).

I applaud your stance, and suggest that you too provide some veracity to your assertions and challenge things which are clearly bogus.

However you have provided nothing to suggest that what these people have said they were told by their surgeon is a lie. Indeed you have mis-represented things and suggested this is "filled with misinformation".

Read carefully as the previous page is people saying "my surgeon said" or "I was told" ... this is not misinformation , it is simply what they were told. It should prompt an intelligent person to discuss this with their surgeon.

Misinformation would be saying "according to the ADA the recommendation is six months" .. nobody has said that.


I try to follow this principle:
https://www.academiccoachingandwriti...rces/citations

I note you provided none in your last reply, so I suggest that unless you do that others can equally say "well that's your opinions only"

Keep up the Good work.

Trust by verify

 

[cldlhd]

First of all the mis-information is right here in this thread. If doctors are recommending the 6 month wait it is NOT based on AHA guidelines. If someone had a serious dental problem they might not give it attention based on the information in this thread. As for myself I did ask both my cardiologist and my surgeon. The surgeon said wait three months. My cardiologist said it does not matter just so long as you pre-med. The cardiologist is correct based on the exhaustive AHA research and resulting guidelines. So trust me I am not " a fool" , however I think as a member of this very serious forum we should challenge misinformation when it is posted repeatedly.

A "serious dental problem" is one thing but if it's just a cleaning then my opinion is what's the rush? I get them every 6 months anyway. I wouldn't automatically base my decision on what someone on a forum said either. In regards to the experts they once thought the earth was flat so they can be wrong as well.I think it's somewhat common sense that if the endothelium hasn't healed yet then the risk of infection would be greater.

 

[mikeccolella]

well given the proportion of information that this thread makes of the entirety of this site I would hardly say that it makes the whole barrel rotten ...



I agree, and you will find many of my posts where I challenge "assertions" which are unsupported. I usually support my views with citations to back them up (or provide them where asked).

I applaud your stance, and suggest that you too provide some veracity to your assertions and challenge things which are clearly bogus.

However you have provided nothing to suggest that what these people have said they were told by their surgeon is a lie. Indeed you have mis-represented things and suggested this is "filled with misinformation".

Read carefully as the previous page is people saying "my surgeon said" or "I was told" ... this is not misinformation , it is simply what they were told. It should prompt an intelligent person to discuss this with their surgeon.

Misinformation would be saying "according to the ADA the recommendation is six months" .. nobody has said that.


I try to follow this principle:
https://www.academiccoachingandwriti...rces/citations

I note you provided none in your last reply, so I suggest that unless you do that others can equally say "well that's your opinions only"

Keep up the Good work.

Trust by verify

Well first of all I certainly never suggested anyone lied. I certainly agree that the posters were simply following what their docs told th em. If it came across that way I apologize c ertainly not intended. As for citations I certainly agree with you, but I assumed AHA Gidelines was citation enough; however your point is Well taken. I do agree with cldlhd that if its not an emergency what the hell why rush into it. My point of course if its serious then hell go with the researchers; of course they could be wrong but I maintain its a hell of a lot better than flipping a coin and we know a hell of a lot of stuff like how to make and replace heart valves because of scientific research.

http://www.heart.org/HEARTORG/Condi...ocarditis_UCM_307108_Article.jsp#.WSwuELEpChA

 

[Agian]

If doctors are recommending the 6 month wait it is NOT based on AHA guidelines.

So what? What's your point?

 

[dick0236]

First of all the mis-information is right here in this thread. If doctors are recommending the 6 month wait it is NOT based on AHA guidelines.......... however I think as a member of this very serious forum we should challenge misinformation when it is posted repeatedly.

Mike, you have referenced a thread that is 5 years old to support your argument that "so much misinformation on this site". I think there has been an ongoing debate about dental work and pre-med for years.....and years. I no longer remember when I had my first dental post surgery visit but I do remember that it was at least twenty years post op before any dentist had me pre-medicate prior to the visit. You've been several months post surgery and if you are having dental issues, I'd talk to the cardio and/or the dentist regarding your current situation. My GUESS is that, if you are having serious dental issues they would OK dental work since you are several months post op.

 

[mikeccolella]

Mike, you have referenced a thread that is 5 years old to support your argument that "so much misinformation on this site". I think there has been an ongoing debate about dental work and pre-med for years.....and years. I no longer remember when I had my first dental post surgery visit but I do remember that it was at least twenty years post op before any dentist had me pre-medicate prior to the visit. You've been several months post surgery and if you are having dental issues, I'd talk to the cardio and/or the dentist regarding your current situation. My GUESS is that, if you are having serious dental issues they would OK dental work since you are several months post op.

Hi Dick, if you had read my post above you would know that i did ask my surgeon and my cardiologist and their answers were not the same which is one reason I am motivated to talk about this issue-so much disagreement.

 

[pellicle]

...that i did ask my surgeon and my cardiologist and their answers were not the same which is one reason I am motivated to talk about this issue-so much disagreement.

Wel why didn't you say so instead of making a bunch of inflammatory remarks about how the site is filled with so much misinformation.

Why not start by saying something like "hey, ive had two conflicting opinions and would like to discuss this issue"

As I mentioned there is a variety of opinion on this matter because few proper studies have been done.

Some searching will reveal a few deaths post surgery and dental work has been implicated.

Another item I found suggests that extractions are not classified as risky from an infection standpoint.

What are your dental procedure intentions?

Perhaps we can then work together to piece together some readings and maybe make some suggestions.

 

[pellicle]

Let me remind you of your first post on this

So many people on this forum claim a 6 month wait for dental work after heart valve surgery. The AHA guidelines NEVER Say this. They only say pre med 2 gms amoxicillin. So much misinformation on this site.

I don't see where you say you wanted to discuss things but I have bolded where you threw down the gauntlet that the site is filled with misinformation ... anyway ....

Firstly I think this paper sums up why there is no clear consensus, but there are indicators:

http://circ.ahajournals.org/content/.../1736.full.pdf

cutting to the chase

Conclusions—The major changes in the updated recommendations include the following: (1).... (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. ...

So in the absence of "firm knowledge" I'd say that its reasonable to take a precautionary approach.

Remember, that what they tell you will be "opinion" ... just that. Their opinion. That's as good as it ever gets.

That paper follows on with this:

Bleeding often occurs during a dental procedure in patients with or without periodontal disease. Previous AHA guidelines recommended antibiotic prophylaxis for dental procedures in which bleeding was anticipated but not for procedures for which bleeding was not anticipated.1 However, no data show that visible bleeding during a dental procedure is a reliable predictor of bacteremia.62 These ambiguities in the previous AHA guidelines led to further uncertainties among healthcare providers about which dental procedures should be covered by prophylaxis.

These factors complicated recommendations in previous AHA guidelines on prevention of IE that suggested antibiotic prophylaxis for some dental procedures but not for others. The collective published data suggest that the vast majority of dental office visits result in some degree of bacteremia; however, there is no evidence-based method to decide which procedures should require prophylaxis, because no data show that the incidence, magnitude, or duration of bacteremia from any dental procedure increase the risk of IE

read that carefully.

It must be emerging by now that certainty isn't one of the things we have here.

At the beginning it mentioned risk groups, so:

Cardiac Conditions Associated With the Highest Risk of Adverse Outcome From Endocarditis
...Moreover, patients with prosthetic valve endocarditis are more likely than those with native valve endocarditis to develop heart failure, the need for cardiac valve replacement surgery, perivalvular extension of infection, and other complications.

so that means us ...
I recommend you read that entire paper if you wish to know more. Its well written.

Still, this paper does not talk in terms of "duration of time after surgery".

To determine that we'd need estimates of how long it would take for endothelisation of the surgical area to occur and protect (by your own bodies cells) the implanted valve (which could be colonised by bacteria).

That too is going to be subject to a lack of data and no way of "looking to see" if its covered.

So its all looking unclear and "uncertain" the more you look at it.

This paper makes the following observation:
http://www.medscape.com/viewarticle/821334

The investigators note that whereas the American College of Cardiology and American Heart Association guidelines consider dental extraction to be a minor procedure, the rate of serious adverse events in this patient series suggests otherwise.

but yet that paper doesn't talk about how long "after surgery" but focuses on dental surgery before OHS and valve replacement.

An amount of searching has not revealed how long it takes for endothelial cells to cover the area of valve implantation. So I'm of the view that this uncertainty drives the uncertainty which is clear in the divergence of opinions you've had.

Has this helped?

 

[cldlhd]

I agree that the disagreement among the experts proves nobody is certain hence my desire to err on the side of caution and wait 8 months for my first post surgery cleaning and take prophylactic antibiotics. I confess I have yet to read all the links posted here but IMO when the AHA says it hasn't been proven the antibiotics help prevent endocarditis thru dental work it isn't the same as saying it's been proven not to work. There's a logical push to limit overuse of antibiotics but instead of telling the big U.S. corporate farms to stop injecting farm animals with antibiotics to make them bigger quicker they're willing to potentially risk the health of heart patients, after all where is our big money lobby? Good luck under the current 'leadership' getting any so called anti business regulation enacted. Sorry that was my rant for the day.

 

[Agian]

I figure if you eat a chicken before a dental procedure you should be covered.

 

[cldlhd]

I figure if you eat a chicken before a dental procedure you should be covered.

I never thought of that. Or you could find a lactating cow.....

 

[pellicle]

I never thought of that. Or you could find a lactating cow.....

go precautionary principle (as I said) ... but the chicken is better in Australia, as we don't need antibiotics as much in our dairy cattle (yet)

 

[cldlhd]

go precautionary principle (as I said) ... but the chicken is better in Australia, as we don't need antibiotics as much in our dairy cattle (yet)

Pell why do you have to take all the fun out of it.
I fear we may be veering slightly off track again boys....

 

[pellicle]

Pell why do you have to take all the fun out of it.
I fear we may be veering slightly off track again boys....

You mean:
[IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/i.imgflip.com\/gdenn.jpg"}[/IMG2]

Make sure ypu eat chicken us all im saying... If you value your health

(Wonder if you need to eat it raw)

 

[Agian]

I never thought of that. Or you could find a lactating cow.....

They use lactating cows to treat pneumonia. Stop spreading misinformation.

 

[Agian]

Whoopsies.