Hi. I’m at high risk of endocarditis as I’ve had it before and have a mechanical valve. I’ve got a couple of dental appointments coming up and the dentist refuses to prescribe antibiotic cover, citing NICE guidelines. M gp is reluctant to prescribe too on the basis of the same guidelines. I don’t have reviews with my cardiologist so can’t ask him. I understand that health professionals are worried about over prescribing of antibiotics but given my risk I didn’t think they’d want to take any chances. Has anyone else encountered this and, if so, what did you do.? Thanks.
Antibiotic cover for dental treatment - British Heart Fou...
Antibiotic cover for dental treatment
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Anon2023
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MilkfairyHeart Star
Hello, Anon2023
This is a recurrent question.
The NICE guidelines regarding the prophylactic use of antibiotics in dentistry was updated in 2016.
Here is a link to these updated guidelines.
nice.org.uk/guidance/CG64/c...
The wording was changed to say antibiotics should not be routinely prescribed in 2016.
There is a list of high risk patients.
I suggest you ask to go through the NICE guidelines with your Dentist and GP and ask them to explain their clinical decision not to prescribe antibiotics. Shared decision making is an expected part of every doctor/ dentist's relationship with their patients.
Alternatively contact your Cardiologist's secretary to ask them to give their advice.
Hi. Thanks so much for your reply. Hope you are doing well. I think the slight change of wording came after the death of a lady from endocarditis after dental descaling. It’s a rare condition and I don’t want to worry anybody else but I’m definitely on the high risk list. I’m just not comfortable taking any risks.
Is it possible to find another dentist or GP ?
Wait for advice from your Cardiologist in writing before you start your treatment ?
Hi. I think I’ll ring the cardiologists secretary tomorrow and ask the question. I’ll put off my dental treatment until I get an answer. There’s a real shortage of dentists and doctors here (like everywhere really) but I’ll look into my options. Thanks again for your response, I really appreciate it.
You need Antibiotic Prophylaxis for any invasive dental work. Go back to your GP and be firm in demanding they prescribe you Amoxicillin. You take 4 500mg Amoxicillin capsules an hour before the procedure.
Hi. Thanks for your reply. The doc rang me earlier and said a filling and descaling wasn’t invasive. I asked her to speak to my cardiologist but I’m not sure what he will say. If I don’t get prescribed them then I’m stuck.
Any procedure that will cause you to bleed is a risk and requires antibiotic prophylaxis. You're high risk for endocarditis so stand your ground and demand antibiotics either from the dentist or GP.
Hi, This is something I've gone through, so can fully understand any concerns you have. I have two mech valves and had Endo, which culminated in a third surgery. I put off going for dental treatment afterwards, until it was pointed out I was putting myself at greater risk of infection. When I eventually had treatment, it was without Antibios, as the Dentist said it wasn't necessary for cleaning/scraping. My understanding is that they will only prescribe them for extractions. Nowadays, I just make sure the Dentist is bang up to date on my meds and health status, but, I dont really think about Antibios. I suppose I trust the dentist to know their job. That said, where mech valves are concerned, in my experience, it doesn't do any harm to query with a Cardiologist.
Jetcat in reply to
The scraping and cleaning part can cause a lot of blood.!!!I won’t have it done anymore. A few years ago I ended up with gum infection due to it with sore swollen gums and looked like last year’s grand national winner.😡
I needed full course of antibiotics. It can’t do your gums any good having a metal scraper causing that.!!
I had a small surgical procedure a couple of weeks ago (unrelated to my heart). The surgeon said that I shouldn’t have any procedures where there is a risk of bleeding without antibiotic cover. I mentioned the dentist and he said I absolutely needed cover. He wasn’t a cardiologist but he wasn’t taking any chances.
Thanks for your reply I really appreciate it 😊
Hello Anon2023, you need to see other medical professionals asap. I also have a mech valve. The UK is a real outlier here. Pretty much any other developed country provides antibiotic prophilaxis for high risk patients. I needed to switch private dentist three times before I found one who agreed with me. However, the easoest thing to do is to contact your surgeon and get a letter that you are at high risk for endo for any dental treatment. I got such a letter upon discgarge and carry it with me everywhere i go. The surgeons opinion overrules every one else in the medical world, so when i show to doctors, i even get antibiotics for procedures that arebt high risk.
I’m a dentist. It’s now pretty clear that prophylactic antibiotics are counter productive. They don’t seem to prevent anything even in high risk patients and the may even increase the risk by leaving the individual with antibiotic resistant bacteria. The only reason for prescribing them is to stop lawyers asking why they weren’t prescribed. Of course there are plenty of medical practitioners out there who haven’t seen the latest research. It was known in the 1970s when I was at dental school that prophylactic antibiotics didn’t work but it took 30 years to make it official. Countries like the USA still throw them around like smarties and they have much many more problems with antibiotic resistant bacteria that we do. If you look hard enough someone will prescribe them for you.
Hi. Thanks for replying. I understand as a dentist you know more about this than me but there seems to be conflicting views, even amongst health professionals. I think there must only be a small group of people who fall into the high risk bracket and other countries continue to prescribe antibiotic cover for them. I’ve also read that cases of endocarditis have escalated in the U.K. following the implementation of the NICE guidance. I understand the risk of over prescribing antibiotics but after nearly dying of endocarditis I’m terrified of taking chances.
That’s the problem. Not everyone is able to keep fully up to date as the advice keeps changing but the science is quite clear. Dental treatment has been blamed for endocarditis for years but people who don’t have dental treatment are just as likely to get it. Prophylactic antibiotics do not reduce the risk and just produce a reservoir of antibiotic resistant bacteria in the individual and in the general population. I.e. They don’t work and do more harm than good
Just to reassure you. In over 40 years in general practice and hospital dentistry and oral surgery I have seen very few cases where dental treatment was found to be the cause of endocarditis. It’s true that the germs that live in are mouths do cause this problem but they get into our bloodstream every day anyway and rarely cause problems. The people who come to harm are normally those who are unaware that they may have an infection and delay treatment and those who are misdiagnosed. If, like you, you know there’s a risk you’ll be ready to seek early diagnosis and treatment and that is best the key to getting cured
Hi. That’s very reassuring. Thanks. My previous endocarditis wasn’t related to dental problems. I’d had a full dental exam and my teeth were in good condition. It followed on from a sepsis infection after my first surgery. I was very unlucky but at least I know what the symptoms are now and would take myself straight off to hospital if it happened again.
in reply to Mentdent
I thought that descaling, with a machine used a high powered water spray, not metal scrapers? I know there are the small instruments to ping any obvious scale off before the deep clean. My vet daughter uses a water gadget for her patients! And pet mouths are YUK compared to human!!
Mentdent in reply to
The machines you are talking about are ultrasonic descalers. They have metal tips that vibrate at a high frequency and use water to cool them and wash away the debris.
Hi, if you have already had endocarditis before that by default puts you into the highest risk category plus the mechanical valve. A mild manual scraping is less risky than when they use the high powered machine descaler. A filling if it’s simple again doesn’t usually cause bleeding. It all has to be risk assessed on an individual basis as oppose to blanket rule for everyone off guidelines.
Hope you get to hear back soon from cardiologist. If you can get Abx I would try and arrange it that every bit of dental work gets done at same time so not repeating any needing of Abx. I only now ever have machine scaling if I’m having some other work done at same time as have the Abx cover.
Like others have said it’s not just dental treatment, anything that breaks the skin is potentially risky eg gardening I always wear gloves.
Knowing the signs and ensuring that if any chance of endocarditis ensuring GP knows you are high risk and doesn’t give you Abx but sends straight to hospital for full investigations.
Sorry for long post but it’s a deadly infection and catching it early or better still taking all measures to prevent it is key.
Good luck 🤞
Hi. Thanks for taking the time to reply. I really appreciate it.
I don’t know the ins and outs of whether antibiotics are counterproductive or not, but I must add that my dentist used to give me a prescription and trust me to take it before my appointments. (I’ve had endocarditis).Now her regime has changed and I must attend two hours in advance, take it in front of them, and sit in the waiting room for two hours!!! It makes me feel like a naughty schoolgirl who can’t be trusted, and is literally such a waste of my time!!
Thanks for replying. I don’t particularly want to sit in my dentists for hours before my appointment but I’ll do it if thats the only way. You’d think that if you are asking for antibiotic cover then they could trust you to take it. They’re probably just trying to avoid litigation. As you have had endocarditis you’ll understand how scary it is. I really hope that you are recovered and feeling better.
I had endocarditis which was not recognised for 2.5 months despite multiple gp and one hospital appointment, by which time it had damaged my heart valves, my spine, and eyes - it was finally found via blood culture tests following an emergency appointment at an eye hospital.
Following recovery and then mitral valve repair, the consultant in infectious disease, and the consultant cardiologist, both recommended amoxicillin before invasive dental treatment. For clarification of what this meant, my dentist wrote to the cardiologist requesting precise details of what should, and should not be done, before she was willing to treat me.
I now have to attend at least an 1 hr before appointments for invasive scaling or dental repair, and have to drink a mix of strong amoxicillin ( about 4x or 5x normal dose) in font of their staff, before treatment.
Guess it is all a matter of balances. The consultants saved my life and I do what they recommend. Every day is a bonus.
Best wishes with your treatment.
Hi. Thanks for replying. You’ve been through so much. I hope that you are doing better now.. My endocarditis was also brewing for months following a bout of sepsis after my first mitral valve replacement. It caused me to have a stroke and another mitral valve replacement. The damage also caused heart failure. It is a devastating disease which I’m keen to avoid again. I was hospitalised for months and it was touch and go. Since discharge from hospital I’ve not seen my cardiologist. Apparently this is the norm unless I have another event. I’m now trying to be proactive with my own health. While I’m keeping on top of my dental hygiene I don’t want to take any risks.
Morning The only advice I can give you is get your GP or Dentist to refer you to your local hospital dental service as I found out they are more flexible getting things done also the have more knowledge to call on.
Good luck
Andy
Hi. Thanks for replying. That’s a really good idea. I hadn’t thought of that. Thanks for suggesting it 😊
Hi. 😊 Thank you to everyone who replied to my post. The people on this forum are so supportive and knowledgeable and it really helps me to be able to talk to people who know what it’s like to live with a heart problem. I didn’t want to scare anyone about endocarditis but it’s something I’d never heard of until I caught it. Although it is a rare condition (even amongst the high risk group) I would suggest that everyone familiarises themselves with the symptoms just incase. If you get the symptoms insist on blood cultures. Mine went undiscovered for months which allowed it to do some serious damage. It’s treatable if caught in good time.
Thanks again to everyone for your support. Xx
Hi Anon2023
I had an aortic valve replacement in January 2021 with a tissue valve.
6 months ago I had a hygienist appointment with no questions asked.
When my next appointment came along my dentist wouldn’t do it without contacting my cardiac surgeon for advice stating that protocol had changed due to endocarditis worries.
Cardiac surgeon duly contacted advised Amoxicillin pre treatment.
I’ve had my appointment. The Amoxicillin was given orally in liquid form at the dentists and I had to sit in the waiting room for an hour to be observed beforehand.
For future treatment I’ve been told it will be the same but I’m to pick up the prescription from my GP a few days before. Seems quite straight forward and I’m pleased with the precautions they are taking now.
I have asked this question here before and it’s apparently for valve patients in particular.
Good luck with your dentist appointment and so sorry you’ve suffered endocarditis before. It must be very scary.
Regards
Maisie
Anon2023 in reply to
Hi Maisie. Thanks for replying to my post. I’m pleased that you managed to get sorted. Hope your tissue valve is working out well. I’ve got a mechanical valve and while the ticking drives me crazy, it’s a minor issue. Endocarditis was incredibly scary, I spent 2 months in hospital on iv antibiotics before further surgery. The surgery took 8 hours to replace the valve again and debride the infected tissue. The incredible surgeon saved my life for which I will always be grateful to him for. I’m perhaps hyper vigilant to the risks of ever getting endocarditis again.
in reply to Anon2023
I’m well thanks. Back to my walking and as well as it gets for my nearly 69 years. Feeling so grateful like yourself for the wonderful cardiac surgeons we have and the NHS staff in general.
You have been through so much. I do hope you find a way through your continuing dental care as it’s so important.
My dentist said I was lucky as they managed to make contact with my cardiac surgeon who got back to them right away. Some people’s surgeons have retired or no longer practice and that’s when it’s difficult to get anyone to take responsibility. That’s basically what it is. Litigation etc. Just as the previous dentist on this thread said. Sad!
Take care
Maisie
Hi. In France no pb to get antibiotics in dentistry for someone in your condition
On a lighter note, during my nine week long hospitalisation I was served cauliflower and broccoli cheese bake frequently for dinner, so sent a pic of how my heart valves looked, alongside one of my meal and asked my grown up children to guess which was which. 😀
Endocarditis
That’s hilarious 😂 I’m really hoping that was the cauliflower cheese. The food in the hospital I was in was equally as bad and I spent a fair bit of time trying to identify what it was. The Costa coffee did a roaring trade in sandwiches.
Nil points! That was the endocarditis!!
in reply to P0rtnahapp1e
That’s not tasty at all. If you think that’s cauliflower cheese then…….🤣
I couldn’t eat a thing in hospital. Don’t know why. Smell, taste, stress!
Did ok when I got home though!
Omg!! Endocarditis is a very nasty infection. I dread to think what mine looked like. The surgeon just said it was “bad”. He was a brilliant surgeon but he was always the master of understatement so I didn’t dare ask more. Probably looked as bd as the bolognaise bake they served. Mind you, the cauliflower cheese looked very similar!! I hope you are doing well now and recovered. 😊
Result!! Probably because I’ve made a monumental nuisance of myself the dentist has decided to prescribe antibiotics. I’m not used to being so demanding with health professionals and there will be people who might say it is the wrong decision but I do feel reassured . Thank you to everyone who replied to my post. As always, I’m very grateful for your support xx
Demanding? Perhaps advocating for yourself.
I went to GP who said we don’t have to listen to nice and gave me the antibiotics after the dentist was not interested in giving them I showed GP the report on the deaths after dental work with no antibiotics
Hi thanks for replying. I contacted my gp who said that I didn’t need antibiotics for non invasive treatment such as fillings and hygienist appointments. I thought these were invasive but she thought not. My dentist has now changed their mind which makes me feel reassured but it goes to show that health professionals have different views on the use of antibiotic cover. While the risk from dental treatment may be low I’d rather not take any chances.
Hi. Thank you for your reply, you have been through so much and I can only hope that you are doing better now.
I turned up at the dentist yesterday and she had changed her mind about prescribing antibiotics. She was citing nice guidelines and said that while I was high risk I didn’t need antibiotics. I was very angry and I cancelled my hygienist appointment. I am going to swap dentists in august when the nhs list opens at another dentist. I was fuming because I’d been lied to and also because it didn’t matter what I said she wasn’t to listen. I fear it has become a bit of a peeing contest where she sees herself as a professional and I’m a scare mongering dim wit.I don’t wish endocarditis on anyone but, like you, I came very close to dying and it would have been nice if she could at least listen to my viewpoint rather than just reading from a script
Stories like yours are very worrying and I really hope that you feel better soon. I wish you all the best for your 3rd replacement valve and for the future. X
So I turned up at the dentist yesterday and she had changed her mind about the antibiotics and so I cancelled my appointments. I’m fuming because I’d b been lied to and because of the dentists unwillingness to budge on her interpretation of the nice guidelines. As soon as I can switch practices I will. I fear it has become a peeing contest and the dentist has now lost my trust and respect. It shouldn’t be like this, especially as I am paying for the privilege.
The reality is that more deaths are caused by the administration of antibiotics in this situation than are prevented. I’m sorry you were one of the unlucky ones but it has been shown that prophylactic antibiotics don’t prevent endocarditis in most cases anyway.
This post has become more and more confusing for me, knowing what to do for the best. I don't currently take antibiotics, but, as someone with two Mech Valves, which have already been replaced or repaired due to Endocarditis, also with Haemolytic Anaemia and Heart Failure, I suspect I'm considered high-risk and may need them. Something to take up with my Cardiologist next month.
Anon2023 in reply to
Hi. Its very confusing because everyone has different opinions. I think you would be included on the high risk list and your dentist should be discussing this with you before any treatment that could lead to bleeding. They should also ask for an inr reading to be done up to 48hours before treatment. I’d definitely speak to your cardiologist and see what they think about antibiotic cover.
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