Predental Antibiotics

[tobagotwo]

I recently had a crown installed. It takes several appointments, for fittings and such. However, the only appointment when there was any involvement of the gums was the initial one, where they pull the gum away from the base of the tooth. There was no gum or bleeding involvement with my other appointments, including replacement filling and the fitting of the permanent crown, which was part of a bridge.

Basically, the thought is that if you didn't have bleeding, there would be no reason to take the antibiotic.

In fact, I have had intestinal problems from taking Amoxicillin 1-2 times a week for several consecutive weeks of dental work that included a bridge. It took me nearly a month to get over the stomach upset, even with regular doses of lactobacilli and related intestinal bacteria. The "good" bacteria are more susceptible to most antibiotics than the bad bacteria.

I was not happy,as the dentist was adamant that I take the Amoxicillin every time I went, even though she was aware that there was no gum involvement at all in several of the visits. I didn't know, so I took the pills, even though I knew they would cause me more problems. I have some concern now whether H pylori or other resistant bad actors had time to colonize while my usual gut fauna were killed off.

It seems that "premedication" is not such a good thing (for me,anyway), if there is no reason to expect the gum to be perforated.

Best wishes,

 

[epstns]

Bob,
I wouldn't fool around trying to avoid pre-medication. The consequences of one infectious episode are too nasty. That said, what I would do is to ask your dentist to prescribe one of the alternative antibiotics for pre-medication. I, too, have nasty digestive reactions to most of the penicillin derivatives, so my dentist prescribes clindamycin capsules. I take 4 caps of 150 milligrams each an hour before my appointment. So far (many visits over two years) I have had little, if any, side effects from this regimen.

Ask -- the American Dental Assn. has several alternative treatments.

 

[Ross]

I second what Steve is saying. While there isn't any real proof that premeding does anything, it is not worth the risk involved to find out otherwise. You may ask about a different antibiotic if amoxicillin isn't your flavor.

 

[tobagotwo]

You guys are totally on the mark with this, and I wasn't thinking of dropping whatever protection may be offered by premedicating for cleanings or unknowns. I've read some of the stories about bacterial endocarditis, and I don't want any part of it, believe me.

I'm just ranting about taking them when the dentist knows darn well that the chance of puncture is, as my periodontist once put it, "the same chance you have when you eat dinner."

The periodontist's view was that premedication was only of real value for procedures like cleanings, extractions, or surgeries, with higher risks associated. He once pointed out that someone performing what he considered good oral home care would have to take them every day, otherwise, and again whenever eating high-risk foods like potato chips (he says people get their gums cut by them all the time).

I never used to have trouble from the Amoxicillin, but I guess my intestinal flora got rearranged by the barrage it went through last time. I will look into clindamycin as a possible alternative, as it might help. I guess I'm feeling defensive, as I have to go back and have an old filling replaced, and I don't look forward to the bellyache afterwards.

Best wishes,

 

[Marguerite53]

Hi Bob.

Hi Bob.

I agree with Steve and Ross. Just take the darn meds!! But, maybe there are some better meds. I'm allergic to penicillin and sulfa related antibiotics. They used to put me on erythromycin. TRY TO AVOID THAT ONE. It will really eat at your gut. I now use clindamycin, also, and it is completely non-upsetting.

You might check with a naturopath now that you are off things since it might be a good time to build up whatever is failing you in the stomach resistance department.

My husband takes Probiotic Pearls. Made by PhytoPharmica they are pretty little pearly round pills that are a "dietary supplement with L. acidophilus and B.longum to increase healthy intestinal flora". I know you've said you're doing the acidophilus routine, and these may be nothing more, but thought it was worth a mention.

Marguerite

 

[Raverlaw]

I've never tried the supplements, but then I eat yogurt almost every day. I find that it is soothing on the (rare) occasion I have an upset stomach, and I suspect the 'good' bacteria in the yogurt help keep the count up in the intestines, even after a good dose of the amoxycillin.

I'm about to get two fillings replaced, a bridge and a crown (I had the extraction done pre-OHS as a precaution) and I know they're going to insist I take the meds. Maybe I'll look for some of the pearls as an extra dose of good stuff...

 

[tobagotwo]

I was taking probiotic capsules daily, sometimes with active-culture yogurt, but it still took a good month.

These have three lactobacillus (l. acidophilus, l. rhamnosus, and l. rhamnosus type b), two lactococcus (l. lactis, l. caesei), biftobacterium longum, streptococcus themophilus, saccharomyces boulardi (yeast), and FOS (bacteria food, I guess, as it looks like a complex sugar).

I'm considering eating dirt next time, 'cause I feel like this should be enough intestinal fauna for anyone. One has to have limits...

Best wishes,

 

[Johnny Stephens]

I had a porcelain crown replaced 2 weeks ago - I was asked to pre-medicate for the 1st appointment (possible drilling and polishing, and the usual gum work). For the 2nd appointment (removal of the temporary and cementing the new crown) he specifically told me *not* to pre-medicate.

I go back on Tuesday for my semi-annual cleaning, but will have to pre-medicate for that.

A minor nitpick - I don't understand the reference to the chance of puncture during a cleaing being the "same chance you have when you eat dinner." It may be low, but it's not *that* low - a least not judging by all the scraping with shiny instruments that goes on during my cleanings.

 

[tobagotwo]

I like your dentist's approach, Johnny. That's exactly what I was talking about. Same, exact situation.

The sentence that concerned you was written about the fitting sessions for my permanent bridge and other low-likelihood procedures, like a small filling on the top of the tooth, "when the dentist knows darn well that the chance of puncture is, as my periodontist once put it, 'the same chance you have when you eat dinner.'"

Not for "...procedures like cleanings, extractions, or surgeries, with higher risks associated." There are always going to be breaches of the gum tissue for those things, including that first visit for a crown or bridge. I certainly wouldn't bypass the pills on those days, or even when I wasn't sure what might happen.

With your permission, I might bring your post to the dentist next time. Maybe she'll reconsider on the no-poke procedures.

Thank you,

 

[Johnny Stephens]

With your permission, I might bring your post to the dentist next time.

Be my guest...

 

[Harpoon]

There are other options besides amoxicillin to take....

What kind of a dosage are you on? Typically it's a megadose of 2000mg an hour before you sit in the chair. There may be other alternatives to this.

Further, my wife was placed on an antibiotic by her dentist AND a suppliment that would help foster the growth of "good" bacteria after she was off the antibiotic. The suppliment she had to buy off the shelf at a GNC nutrition store. Perhaps something similar might be recommended for your case, taking the antibiotic and something else that supports the good bacteria at the same time.


Dunno, it might be worth talking over with your PRIMARY physician or a cardiologist rather than just your dentist. Sometimes they've got a better handle on what's out there for a variety of different circumstances rather than simply dental guidelines for prophylaxis before an appointment.

 

[tobagotwo]

Thanks to Steve Epstein, I did get switched over to a different predental antibiotic, clindamycin, which should be easier on my personal flora and fauna.

I am still going to wave the post from Johnny Stephens, The Lovely And Talented, at my dentist, and see if she will loosen up on the non-invasive days.

Thank you all,

 

[ALCapshaw2]

Another alternative, approved by the American Heart Association, is Azithromycin, 500 mg (2 tablets of 250 mg from a Z-pak).

I take an Acidophilus supplement to restore the 'good' bacteria.

'AL'

 

[Harpoon]

... which should be easier on my personal flora and fauna...

Ummmm... Not to nit-pick here but, there REALLY shouldn't be any "FAUNA" running around in your system....





Didn't know Z-Pak was a suitable substitute for amoxicillin like that. I had that stuff a few years ago when I had a NASTY case of bronchitis (or was it the flu?) worked great though it took a day to really be noticable and I had to restrain myself after the third day from getting back into my old routine at the time (I was very busy back then) because I knew I was still pretty sick even though I felt so much better.

Good stuff for anyone that might need it.