dental treatment and antibiotic cover

[Anon2023]

hi everyone just a quick update following my post about dental cover for those with prosthetic heart valves. As you know, my dentist was very reluctant to offer antibiotic cover even though I’m considered high risk for endocarditis (mech heart valve and previous endocarditis). I’ve had a bit of a battle with them and cancelled my dental appointments until she wrote to the cardiologist for advice. She did so but wasn’t happy, I got the impression she thought she knew better than the cardiologist. Anyway the cardiologist has now written to say it would be indefensible for her to carry out invasive (anything that causes bleeding) dental work on me without antibiotic cover. I would encourage anyone who has a mechanical heart valve and previous endocarditis to get such a letter. Why take the risk if you don’t have to for the sake of taking 50p”s worth of antibiotics? Endocarditis is a horrific thing and while the risk with dental treatment is low, it can happen. Take care.

[MoyB]

Your post is interesting. Years ago, my husband was seen by a cardiologist who diagnosed a heart murmer and said he should (a) carry a cardiac alert card and (b) always take antibiotics before any dental work.

His wallet was stolen a couple of years later and with all his cash and bank cards went his Cardiac Alert card. We were never able to replace it! A call to the hospital got us nowhere. We were told to call the GP - and were told then to call the hospital or the pharmacy! No one had heard of such a card! So he has not had one since.

However, his dentist was keen to comply with the 'antibiotic before treatment' regime as he said his dental training strongly supported doing that .

Then, a few years ago, the dentist told my husband that new guidelines meant that he no longer had to take the antibiotics before treatment. The dentist was not particularly happy about this as he said it had been drummed into him that he must NOT treat a patient with a heart condition of any kind, without antibiotics first!

So we now move on to November 2021 and my husband received a pacemaker, a new heart valve (pig) and instructions to take antibiotics before any invasive dental procedure such as tooth extraction. He feels a little nervous going for fillings as he is told each time that he doesn't need to take the antibiotics and, to be fair, he's been fine.

I am pleased that you've been told to take them as a colleague of mine almost died following dental treatment that led to endocarditis.

I also lost a grandfather to endocarditis many years ago and almost lost a cousing to it a few years back. It is not something to be trifled with and if it can be prevented (in most people) by taking an antibiotic, I don't see why you shouldn't have it!

I might change my dentist, if I were you.

xx Moy

[Anon2023 in reply to MoyB]

Hi. Thanks for your reply. I think the NICE guidelines identify a “high risk group” where antibiotics should be considered for dental treatment. I was in that group as I have a prosthetic valve (metal) and Ive had endocarditis before. I nearly died in January because of endocarditis and spent months in hospital. I kicked up a fuss with my dentist because I’d rather do anything than end up with endocarditis again. I hope your husband is doing well now. If he is anxious perhaps he should ask the cardiologist for an opinion on whether he needs antibiotics for fillings etc. good luck and thanks again.

[Anon2023]

Hi. Thanks for replying. I remember your last reply and your experiences with endocarditis. Like you, I am completely at a loss as to why some dentists are reluctant to prescribe antibiotics. My dentist basically told me that she knew better than the cardiologist and I got the impression that it was all about her ego. Needless to say, I have tried to find another dentist but there aren’t any dentists taking new patients in are where I live. I’m hoping that now the cardiologist has put his concerns in writing that she would dare not undertake my work on me without antibiotic cover. I won’t have any treatment without it even if I have to walk out on the day. I don’t understand why it has to be such a battle.

[Anon2023]

I completely agree with you. I posted because I was worried that other people with mechanical valves weren’t always aware of the risks. When I did cardiac rehab there were people there who hadn’t been told about dental treatment and the need to look after our teeth due to endocarditis. Im really not trying to be a scaremongerer but I think people should have enough information to be able to make informed decisions about their health. After my first valve replacement nobody mentioned dental treatment and I didn’t know what endocarditis was until I got it.

[Hidden]

I'm due a dental appointment in September, and until your posts I would have just gone along and not questioned anti-biotic cover. The dentist is well aware of my medical history, including the Endocarditis and it never bothered him at all. I have a Cardiology appointment next week, so I intend asking the Cardiologist his views on the matter. The more I think about it, it seems bizarre that I don't have cover.

[Glemham in reply to Hidden]

The cardiologist , who repaired my mitral valve, said he wouldn’t dream of having dental treatment himself without antibiotics, if he had serious heart issues. I’m lucky, as my dental surgery was informed I should have antibiotics and I always have had them when required.

[Anon2023]

I’m sure most dentistry is relatively low risk but I was told by a surgeon to always have antibiotic cover. I think everybody is worried about antibiotic resistance but I had months of iv antibiotics in hospital when I had endocarditis so I doubt if two more amoxicillin tablets will make much difference. I know that my cardiologist is very much in favour of antibiotic cover and that’s good enough for me. It’s definitely worth asking the question. I think anyone who has had endocarditis has been very unlucky to begin with and we hope that lightning won’t strike twice. Unfortunately it does. Personally I’m very risk averse so I’ll ask for antibiotics every time.

[Anon2023]

Hi. I’m amazed that people aren’t told about endocarditis so that they can at least recognise the symptoms and get prompt treatment. I originally thought I had the pandemic virus until the tests came back negative.

[Anon2023]

I’m pleased that you have such an understanding and caring dentist. In the end my cardiologist had to write to my dentist telling them that it would be indefensible to do any work without antibiotic cover. I just don’t understand the level of resistance that I encountered from the dentist. I imagine they might feel differently if they had ever experienced endocarditis themselves. Take care.