Tooth Extraction

[3mm]

I will be having a tooth removed Thursday. Since I have an On-X mechanical, and I've had endocarditis in the past, I will take amoxicillin 1 hour before the tooth extraction.

What about antibiotics for a few days after the surgery? What are other mechanical heart valver's experience with tooth extraction?

I will be talking with my oral surgeon Monday, and with my cardiologist on Tuesday about this. Endocarditis scares me!

Thanks.
mTm

 

[Chuck C]

2,000mg of amoxicillin 1 hour before the procedure would be per the guidelines. I don't take antibiotics other than the standard prophylactic dosage prior to dental procedures. But, I have not had endocarditis before. I'd run the idea of taking it for a couple of days after the procedure by your cardiologist. I doubt that it would do much harm.

 

[3mm]

I just talked with the oral surgery office. I'll take the usual 2,000mg of amoxicillin 1 hour before the procedure, and they will also prescribe amoxicillin for 7 days after surgery.

 

[Deepak khanka]

I will be having a tooth removed Thursday. Since I have an On-X mechanical, and I've had endocarditis in the past, I will take amoxicillin 1 hour before the tooth extraction.

What about antibiotics for a few days after the surgery? What are other mechanical heart valver's experience with tooth extraction?

I will be talking with my oral surgeon Monday, and with my cardiologist on Tuesday about this. Endocarditis scares me!

Thanks.
mTm

Hi , just for my knowledge after you came to know you had endocarditis what was the next plan of action?

 

[3mm]

My endocarditis was from Staphylococcus Epi, which the infectious disease Dr said is easy to kill. After about a week of antibiotics, my blood cultures were clean. But we kept me on various antibiotics via IV for another week. Then I did antibiotic infusions via a permanent IV line for another 4 weeks. Fortunately, I did those myself at home. Then I had 5 months of antibiotic pills. Meanwhile the cardiologist and a surgeon started to talk with me about heart surgery, because I had major damage to my mitral and aortic valves. I was also recovering strength during this time. In Sep, 2023 I had surgery; this was 10 months after the endocarditis. We could have done surgery much earlier, but I wanted to get stronger first.

 

[mecretired]

Just to relate my similar experience—I had endocarditis about 5 yrs ago—strep. Have no idea how I got it. Spent 7 days in the hospital and went home with a picc line and 6 weeks of iv antibiotics. All was good. Just over a year later I had a second round of endocarditis—strep but a different strain than first time. Spent 6 days in the hospital and went home with a picc line and 4 weeks on iv antibiotics. Fortunately they found no damage to my valves. But since I had it twice cardiologist and infectious disease dr decided to keep me on antibiotics. I have taken cephalexin 2x day for 3 yrs now. This is a relative of penicillin. Since I’m allergic to penicillin I take Zyrtec for my hives. Si will probably be on this antibiotic the rest of my life. I do now use a water pic instead of flossing and use listerene before brushing.

 

[Deepak khanka]

So sorry as well as shocked to hear your cases. It’s so unexpected

 

[ATHENS1964]

Antimicrobial prophylaxis againstinfective endocarditis in adults andchildren undergoing interventionalprocedures .Full-quideline
https://www.nice.org.uk/guidance/cg64/evidence/full-guideline-pdf-196759981

 

[Jeff Lebowski]

My tooth, which has not hurt for years, started to hurt two months after heart valve surgery. In fact, sensitivity occurs when eating or drinking something cold rather than pain.

Tomorrow I will go to the dentist for a check-up, if the aching tooth needs to be filled or extracted, of course I will first go to my cardiologist. My only and most important fear is endocarditis, I hope I will not experience any negativity.

I think the cardiologist will adjust the Warfarin dose before the dental operation. My INR value is between 2-3

 

[ATHENS1964]

My tooth, which has not hurt for years, started to hurt two months after heart valve surgery. In fact, sensitivity occurs when eating or drinking something cold rather than pain.

Tomorrow I will go to the dentist for a check-up, if the aching tooth needs to be filled or extracted, of course I will first go to my cardiologist. My only and most important fear is endocarditis, I hope I will not experience any negativity.

I think the cardiologist will adjust the Warfarin dose before the dental operation. My INR value is between 2-3

The dentist will make the treatment plan, for a simple filling and even extraction, the cardiologist is not needed, the only thing that will be needed is amoxil antibiotic according to the protocol .

 

[Jeff Lebowski]

The dentist will make the treatment plan, for a simple filling and even extraction, the cardiologist is not needed, the only thing that will be needed is amoxil antibiotic according to the protocol .

At the moment, there is a sensitivity in my right back upper molar tooth, there is no severe pain, only a slight tingling occurs when it comes into contact with hot or cold foods. Of course, this will be determined tomorrow, but according to my estimation, there may not be a situation such as tooth extraction.
However, as far as I understand, you say that I should definitely use antibiotics even if a filling or other treatment will be performed. But will I take the decision to use antibiotics myself? Or will the cardiologist make this decision? This seems to be a bit sensitive, and will there be a need for a change in my Warfarin dosage? For these reasons, I am considering going to the cardiologist.

 

[dick0236]

However, as far as I understand, you say that I should definitely use antibiotics even if a filling or other treatment will be performed. But will I take the decision to use antibiotics myself? Or will the cardiologist make this decision? This seems to be a bit sensitive, and will there be a need for a change in my Warfarin dosage? For these reasons, I am considering going to the cardiologist.

For the past 40 years I have taken an anti-biotic (amoxicillin 2000mg) before any dental work......cleaning, extraction, filling etc. Better safe than sorry.

As far as I know, I have never had my cardio involved in any dental decision......my dentist has always prescribed the Amoxicillin.

I have never held or reduced my warfarin for any dental work I have had done.........extractions, deep cleaning, root canals, etc. and have never had excessive bleeding at the dental work site.

This has been my practice for at least 40 years. Before that, I didn't even take an anti-biotic......the after-valve care has improved greatly since the early years.

 

[Jeff Lebowski]

I always take an anti-biotic (amoxicillin 2000mg) before any dental work......cleaning, extraction, filling etc. Better safe than sorry.

In my appointment with the dentist tomorrow, only the condition of the tooth will be checked, maybe an x-ray will be taken, apart from these, no intervention will be made to my tooth. should I take antibiotics for this examination?

 

[dick0236]

In my appointment with the dentist tomorrow, only the condition of the tooth will be checked, maybe an x-ray will be taken, apart from these, no intervention will be made to my tooth. should I take antibiotics for this examination?

I would not think you need an antibiotic for simple evaluation or x-ray.

 

[pellicle]

only the condition of the tooth will be checked, maybe an x-ray will be taken, apart from these, no intervention will be made to my tooth. should I take antibiotics for this examination?

to me "if nothing is being done" why would you need antibiotics?

do you take antibiotics before brushing and flossing?

Yes that seems ludicrous when I phrase it that way, but that's why I phrased it that way. A basic understanding of the issues is critical to understanding why we use prophylactic measures.

I wear heavy gloves and a mask when welding ... but I don't to pick the welder up and move it around the shed.

We presecribe antibiotics when having a sharp tool scrape up and down inside the space between your gums and teeth breaking off the filth and biofilm and indeed calcified biofilm (called calculus) filled with bacteria (that have gone from planktonic to sessile like a coral reef) and spreading that bacteria (that we've just kicked out of their homes onto the street) around the wounds we are making with the sharp scraper.

So you get scratches and (quite minor, but still) injury from that dental operation (descale). By comparison an extraction is quick and the whole festering thing is taken out.

Prophylaxis is for prevention of an outcome from an action. No action equals no need for prophylactic ...

I hope that analogy helps.

Best Wishes

 

[Jeff Lebowski]

to me "if nothing is being done" why would you need antibiotics?

I know exactly what you mean, Pellice. I think I may be a little too sensitive and compassionate because I am going to the first dental examination after mechanical aortic valve surgery. Before sitting in the dentist's chair, I should tell the dentist that I had aortic valve surgery just in case.
I would also like to ask this, in some publications it is said that antibiotics can be taken 2 hours after the dental operation. What is your opinion about this?

 

[pellicle]

Hi

I think I may be a little too sensitive and compassionate because I am going to the first dental examination after mechanical aortic valve surgery

totally understand, I'm sorry if my reply seemed to err on the more stern side of clear. Chalk that up to me being an Australian (and an older X-er at that, not a Gen Z)



it is also always good to ask

I would also like to ask this, in some publications it is said that antibiotics can be taken 2 hours after the dental operation. What is your opinion about this?

given that this is my opinion (and even "medical opinion varies") I'll say that: before is better but shortly after is better than not.

We know its not there long:

Elimination: Amoxicillin has an approximate half-life of 61.3 minutes, and about 60% of the administered dose is excreted in the urine within 6 to 8 hours. Co-administration of probenecid can delay amoxicillin excretion, as the majority of the drug is eliminated unchanged in the urine.
(source)​

but we also know that it works not by killing but by stopping cell wall growth and thus reproduction ...

Amoxicillin competitively inhibit penicillin binding proteins, leading to upregulation of autolytic enzymes and inhibition of cell wall synthesis​

(source)

What you don't want is something lodging in a corner of a scar tissue crevice and then starting a family (from itself) leading to eventual endocarditis ... manifesting months later.

So if you feel worried, just take 2g as soon as you can.

Best Wishes