Pre-Medication for Visits to Dentist ?

[Guest]

Yep ... I also take 4 Amoxicillin 1 hour prior to any of my dental appointments.



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[carolinemc]

Just got on and I have always medicated before any dental procedure, even cleaning. The destist will not touch you unless you are premedicated. It is to try to prevent encardotis[infection of the heart]. Be sure to do this everytime, it is not good to take not one chance without premed. Just helping out. Have a good holiday weekend

 

[Jason]

My surgeon, PCP, and Dentist all go with premedication. My surgeon says that while it may be overkill, why not?

 

[Michellemar]

My dentist wants 4x Calefalexion (kephlex?) taken I hr prior, and also 2x 500mg Ceflex when the appt is over.
However right now I'm in a "wa wa land" of trying to find out what to do; I carry this constant .5 degree, up or down, the Cardio says it's just being in post-op mode with a new heart structure to figure out...I mean talk about personal! Just wish I'd pull together faster. Have been able to lose the Amiderone but it has so many side effects ------
I can't get a good, reliable stool softener... Any ideas.?
Every day the sun shines more beautifully, playing with the linen curtains, and trying to seduce me into going OUT there!! Michellemar

 

[Superbob]

I have pre-medicated with 4 500mg amoxycillian before dental visits for cleaning, fillings, etc. for a long time. It used to be 4 tabs before visit and 2 tabs after the visit. No big deal and has had little effect on INR. I favor the anti-biotic use to kill any little critters the dentist might stir up.

Exactly the same for me. For a great many years before my surgery, I was instructed to pre-medicate for dental work, and this has continued in the six years since my surgery. My dentist and his assistants never fail to ask if I have pre-medicated before they start their work. As Dick indicated, the standard recommendation has changed over the years -- used to be you took the antibiotic after the procedure as well as before, but now it's 4 pills one hour before the dental work. I take amoxicillin 500mg. Never had any problem.

 

[sweetmarie]

Glad I found this thread. I had AVR in January-11 and since my family doc told I no longer had to take antibiotics prior to dental work because I now had had an artificial valve and infection was no longer a concern. I thought that made sense at the time but I'll be asking her and my dentist about this matter.

 

[ottagal]

Glad I found this thread. I had AVR in January-11 and since my family doc told I no longer had to take antibiotics prior to dental work because I now had had an artificial valve and infection was no longer a concern. I thought that made sense at the time but I'll be asking her and my dentist about this matter.

Sweetmarie,
I would bring a copy of the newest guidelines with you to your next appt. Your doctor may not be updated on this, but hopefully your dentist will.
LynW provided a link to a condensed version in this thread.

 

[Greg a]

Sweetmarie, I premedicate with a dacron ring on my mitral valve on the advice of both my cardio and dentist

 

[Eowyn Rose]

I have pre-medicated with 4 500mg amoxycillian before dental visits for cleaning, fillings, etc. for a long time. However my Cardiologist informed me that the guidelines have changed in Australia. I never had any side effect and noticed that my skin became very clear and healthy looking. This usually gave me the satisfaction that my body still responded well taking amoxycillian and would be able to rid me of an infection who could be dangerous
I just had my first visit to the dentist without a dose of amoxcillian, and I was not worried, However I believe that oral hygiene is very important for my health and make sure I take great care of my teeth and gums.

Eowyn Rose

 

[Greg a]

I have pre-medicated with 4 500mg amoxycillian before dental visits for cleaning, fillings, etc. for a long time. However my Cardiologist informed me that the guidelines have changed in Australia. I never had any side effect and noticed that my skin became very clear and healthy looking. This usually gave me the satisfaction that my body still responded well taking amoxycillian and would be able to rid me of an infection who could be dangerous
I just had my first visit to the dentist without a dose of amoxcillian, and I was not worried, However I believe that oral hygiene is very important for my health and make sure I take great care of my teeth and gums.

Eowyn Rose

WELCOME to the FAMILY we are all brothers and sisters in OHS I see that you found the site in 2004 and joined in 2009 but this being your first post I thought I would send salutations out and look forward to you input on the board now that you have "broken the ice"

 

[ottagal]

I have pre-medicated with 4 500mg amoxycillian before dental visits for cleaning, fillings, etc. for a long time. However my Cardiologist informed me that the guidelines have changed in Australia. I never had any side effect and noticed that my skin became very clear and healthy looking. This usually gave me the satisfaction that my body still responded well taking amoxycillian and would be able to rid me of an infection who could be dangerous
I just had my first visit to the dentist without a dose of amoxcillian, and I was not worried, However I believe that oral hygiene is very important for my health and make sure I take great care of my teeth and gums.

Eowyn Rose

Welcome to the VR family! Glad to see you post. I agree that daily, diligent oral hygiene is imperative for us.

Here is your link to the latest Australian therapeutic guidelines (2008) for antibiotic prophylaxis in cardiac patients:
http://www.tg.org.au/uploads/PDFs/Prevention of endocarditis.pdf

These guidelines state that "antibiotic prophylaxis is now recommended only for patients
with cardiac conditions associated with the highest risk of adverse
outcomes from endocarditis" which includes:
-prosthetic cardiac valve or prosthetic material used for cardiac valve
repair
• previous infective endocarditis
• congenital heart disease but only if it involves:
–– unrepaired cyanotic defects, including palliative shunts and
conduits
–– completely repaired defects with prosthetic material or devices,
whether placed by surgery or catheter intervention, during the first
6 months after the procedure (after which the prosthetic material
is likely to have been endothelialised)
–– repaired defects with residual defects at or adjacent to the site of a
prosthetic patch or device (which inhibit endothelialisation)
• cardiac transplantation with the subsequent development of cardiac
valvulopathy
• rheumatic heart disease in Indigenous Australians only


I am curious as to why your cardiologist is no longer recommending antibiotic prophylaxis for specified dental procedures as you have a prosthetic cardiac valve?

 

[njean]

I've always pre-medicated before dental visits.

For years I had to take (4) amoxicillin tablets before the procedure and then 4 more after. Now, I take the meds an hour prior to the dental appointment. And for years I had to take the tablets that were NOT coated......they were horrible and big as horse pills. Now I take the ones that are coated which make them easier to swallow....they are still HUGE though!

 

[guyinva]

My surgeon, PCP, and Dentist all go with premedication. My surgeon says that while it may be overkill, why not?

I agree with Jason, better to be safe than sorry!

 

[normofthenorth]

A few points that I think are facts:
1) The new guidelines make a pretty sharp distinction between "normal" HVR patients (including BAVers) who are pre-op (who USED to pre-medicate but are now told NOT to) and those who are post-op (who have ALWAYS been told to pre-medicate, and still are).
2) According to my reading, patients with MECH HVs are just as vulnerable to infectious Endocarditis as those of us with TISSUE HVs. Endocarditis attacks the tissues around the valves and causes "vegetative growth" that can clog valves, so I think it's scary for all of us. (@sweetmarie)
3) The guidelines -- old and new -- are just that, GUIDELINES. They are admittedly broad-brush compromise tradeoffs, made in the face of a remarkable lack of hard evidence. (E.g., "Although it has long been assumed that dental procedures may cause IE in patients with underlying cardiac risk factors and that antibiotic prophylaxis is effective, scientific proof is lacking to support these assumptions.") What we DO know is that IE is especially scary for post-op HVR patients, which is why the guidelines (and the surgeons, cardiologists, and dentists) continue to recommend pre-medication for us post-ops, even if there's little or no evidence to show that it helps.
4) The down-side of overuse of antibiotics is not limited to immediate side-effects! As we all know, all humans in 2011 are at increased risk from a growing number of antibiotic-resistant bacterial infections. Offhand, I can think of C. difficile, MRSA, & some resistant strains of e.coli, but I think there are lots more. The more we (over-)use antibiotics, the more we "educate" the bacteria to be resistant. Big Pharma is trying to develop new antibiotics to stay ahead of the "arms race", but all the experts seem to think they're falling behind. I BELIEVE that this is both a collective problem AND an individual one: I.e., (1) collectively, if we overdose our feedlot cattle and fish-farm fish with -cyllin drugs, we are all at increased risk. And (2) individually, people who take lots of -cyllin drugs may be at higher risk of "breeding" their own population of "super-bugs" than people who don't.

If that last "belief" is wrong, please correct it, because it's important here. One article -- http://www.bmj.com/content/340/bmj.c2096.full -- says that it's true, and that the effect "is greatest in the month immediately after treatment but may persist for up to 12 months." Since most of us get our teeth cleaned (or worked on) several times a year, we who pre-medicate (and our own "bugs") are apparently more "antibiotic-resistant" than the rest of the population.

DISCLAIMER: I am not suggesting that anybody change their practice, least of all that anybody disobey their doctor's (or doctors') orders, or do anything else. I think the new guidelines are reasonable, and I'm following them. But I'm also very impressed by how little evidence there is behind them.

 

[normofthenorth]

BTW, I'm pre-medicating with the usual 4x500mg of Amoxycillin each time.

But in addition to that, when I go in for "minor" oral surgery in a couple of weeks (I'm getting the bases for a few "implants" put in), I will be pre-medicating AND POST-medicating (3 x 250-mg Amoxycillin per day for a week). That's my periodontist's STANDARD regime for ALL of his patients who get that procedure. I assume it's as much to prevent oral infections at the surgical sites, as it is to prevent Endocarditis.

 

[sue943]

In the UK (and here we follow them) the NICE guidelines say premedication is not necessary or desirable, however I am treated at our hospital for my dental care and after discussions with my cardiologist it has been decided that I can have antibiotic cover prior to treatment such as cleaning or extraction. I take 3 grams of amoxicillin. I have already had endocarditis and have two replacement valves, I really want to minimize getting it again.

 

[sweetmarie]

Spoke to my dentist and he recommend I continue pre-medicating. I have no adverse reaction to the amoxicillin at all. Then I spoke to my family doctor yesterday and reminder her that she had told me that it wasn't necessary when I phoned her two weeks ago, she checked again and reported that yes, it is recommended. She then went on to say that the guidelines are forever changing, I have to agree with her on that, just by reading all of your threads from around the world. I don't mind taking the antis couple times a year.

 

[Gail in Ca]

I also take 2 grams of amoxicillin 1 hr before dental appointments. My surgeon said I was definitely an at risk patient, with 3 surgeries behind me.
Just be sure you know the symptoms of bacterial endocarditis, because it often isn't caused by the staph that lives in the mouth. I was lulled into thinking I was protected because I took antibiotics before dental appts. I was so wrong! I got a different kind of staph, not caused by dental work or an unhealthy mouth.