Antibiotic Prophylaxis

[Infinity99]

Does anyone with a mechanic / artificial / prosthetic heart valve take 3g dose of Amoxicillin before having invasive dental procedures! Even just for a scale and polish? I think the advice from NICE since 2008 has been for dental professionals to not offer patients antibiotics routinely, but high risk patients should continue being given antiobiotics. There have been some tragic cases of Infective Endocarditis recently due to dental work and wondered if anyone out there had any advice please.

[Lucybird]

I've had fillings since and my dentist and cardiologist say it's no longer necessary. My dentist does like to know my INR though in case of bleeding

[Infinity99 in reply to Lucybird]

Hi Lucybird, thanks for this much appreciated.

[Mary_Janet]

Hi Infinity

I fall into the category above as a high risk patient. In 2017 I lost a filling which was replaced 48hrs later ,as there wasno pain I did not rush to get it seen to.

Ten days later I was admitted to hospital and diagnosed with endocarditis the bugs having entered my system when the filling was out. Unknown to me (or anyone else) I had a severely stenosed bicuspid aortic valve. Anyway nine weeks of treatment including mechanical valve replacement I started a long recovery back to health.

My dentist was very careful and discussed my treatment plan with other dentists across central Scotland.

I take 2grams of amoxicillin I hour pre treatment and also have to do an INR ( I self test). I see the hygienist every three months and the dentist every six months . Apparently I am the only patient in the practice who is on this regime ! I do know that antibiotics are not used routinely prophylactically but I am classed as a high risk.

Last November I had a routine echo which my cardiologist reported back to me by letter. In the letter he stressed the importance of dental care. NB before my illness I had good dental hygiene.

Not sure if this helps or answers your question

[Infinity99 in reply to Mary_Janet]

Hi Mary Janet, thank you for your reply. I have read the Scottish dental board’s recommendations as they have updated the NICE one last year I think. Crucially they have made it clear that high risk patients should have antibiotic pre treatment. Do you take 2gms of Amoxicillin before your hygienist appointments too? Or just any invasive treatments like filings root canal etc.

Thank you

[Mary_Janet in reply to Infinity99]

I have anti biotics before each hygienist appointment. Not needed for a straightforward dental check but I always have had them twinned with the hygienist . Thankfully I have not required anything more invasive but when that I expect the antibiotic cover will be reassessed and possibly increased.

On a side note the one off dose of antibiotics dose not appear to upset my INR which I check a week post treatment. It's a bit of a palavar but worthwhile to prevent further endocarditis!

[RAS53]

Good Morning Infinity99,

I was advised by the Royal Brompton Hospital where I had my AVR last year that I should take prophylactic antibiotics prior to any invasive procedure whether it be dental or surgical - so I take Amoxicillin Sachet 3g (sugar free) 1 hour prior to dental treatments but the antibiotic cover is not necessary for dental examinations.

I am a retired Dental Surgeon and throughout my career the advice whether or not to have antibiotic cover changed several times but as far as I am now aware it is given on a case by case basis depending on the patients condition. You might find this website of interest:dentalprotection.org/uk/art...

Good luck with your treatment.

[Gundoglady]

I see my dentist every 6 months, I have always been asked if any meds have changed, she always cleans and polishes my teeth at every visit, I don't have antibiotic cover for this, and I haven't had to have any other work done since before my new valve was fitted 7 years ago, but I do remember being told that nice had advised that antibiotic cover was no longer necessary.

[Infinity99]

Hi everyone, thanks for your comments. I have since found out that the guidelines issued in 2008 state antibiotic prophylaxis should not be ROUTINELY recommended for dental procedures, BUT some high risk patients should have this advice reviewed.

I attach a link to these amended guidelines that were issued in 2018, that state patients with prosthetic heart valves undergoing invasive dental procedures SHOULD have antiobiotic prophylaxis. The risks to these patients getting Infective Endocarditis is much more potentially fatal than other patients that are not high risk.

sdcep.org.uk/published-guid...

I am also waiting for a call back from the cardiology team to confirm this advice.

[not2worry]

Cardiologist here in the States still recommend taking a prophylactic dose of antibiotics with valve replacements.

In the last decade research has shown a link between dental health and CAD.

We brush, floss and use a water flosser every day for the last 5 years. We have had no major colds, flu or health issues. It appears the gums in the mouth are a primary transporter of infectious disease. During dental work the gums can dislodge hidden stuff in your mouth right into your blood steam.....affects all folks getting dental procedures but with a valve or recent coronary procedures most docs want you to be safe rather than become infected by floating bacteria.

You can buy a water flosser on Amazon for less than $50 and you will be surprised how much stuff we miss when we brush and hand floss!

[Infinity99 in reply to not2worry]

Hello Not2worry,

Thank you for your comments. I think most countries in the world agree with the American Heart Association’s recommendation to continue with antibiotic prophylaxis. However in the UK the health bodies are worried about overuse of antibiotics. It seems they think that patients with heart valves should wait until they get Endocarditis without realising the devastating consequences of fighting this.

However I now have my GP who is willing to prescribe the oral Amoxicillin pre treatment of 3gm sachet before I see the hygenist. I also have an electric toothbrush, floss daily but good idea about the water flosser. I don’t eat much sugar in my diet either.

[Fredders]

My dentist has said that he would give me antibiotics if he had to do anything invasive. I have a mechanical aortic valve but also have the added complication of no spleen. My cardiologist also said I should have antibiotics for any invasive dental treatment.

Wendy

[dawnz]

I take antibiotic cover when I have my twice yearly hygienist apt and any invasive dental work. Scaling procedures can cause the gums to bleed and this could become an infected site. I was told from childhood - I have congenital HD, that gum and urine infections reach the heart the quickest.

The advice since 2008 has been (quietly) revised because deaths from infections following dental procedures are on the increase. I was told this by my dentist and seconded by a Locum, but don't have figures.

I had endocarditis and a heart attack nine years ago, and have three leaking valves. I have had antibiotic cover since, but quite often have a tussle with whichever GP I see for a prescription. I ask them to read my latest notes from the Brompton , where insistence on cover is reiterated. My advice would be to ask your Consultant to write a letter that you can show you GP so you always get cover. Hope that helps

[Rosanna75]

Hi there,

I was asking the same question couple of months ago.

Please be aware that the NICEguideline have been updated recently so the ones form 2008 have been replaced .

This is the updated advice from NICE

Antibiotics should be given to the following group of patients.

'Patients at high risk: replacement heart valves or prior endocarditis.

Patients at moderate risk: native valve disease.

High-risk dental procedure: extraction, deep descaling.

Antibiotic prophylaxis: indicated for people at high risk having high-risk dental procedures. Record details of consent process in the dental notes. Use amoxicillin 3 g or clindamycin 600 mg orally 1 hour before.

Other advice: dental surveillance 6-monthly (high-risk patients) or annually (medium-risk patients); avoid tattoos and intravenous drug use.

Your dentist should be aware of it. Mine wasnt aware as well so I had to write him an email and encourage him to do some readings

Hope this help

Rosanna

[Recoder_Bill]

My dentist is very cautious. I was diagnosed with aortic incompetence in the 70’s and I’ve been taking amoxicillin prior to dental work, not including just a check-up, ever since. Since that time I have had an AVR and recently aortic root and hemi-arch replacement, so now it is de rigour.