Antibiotics and dentist

[francesw47]

Morning. This old chestnut again I'm afraid. I spoke to my sister yesterday evening. She has had aortic valve replacement. She said her dental hygienist refused to carry out a clean without prophylactic antibiotic cover. NICE guidelines have changed. Her dentist was not so sure. Long story short - she has a prescription for Amoxycilin. I always have antibiotic cover - the cardiologist insisted on it and as I'm now on my third valve I guess I fall into the category of people at risk of endocarditis. I can't find the newest NICE guidelines on this subject - any ideas? She'd quite like to continue her regular dental treatment without hassle. Any knowledgeable person who can help?

[Purpleazalia]

The screenshot below gives search addresses, and this is a link to a BHF article:

bhf.org.uk/informationsuppo...

Extract from NICE pdf about having dental treatment and heart problems

[francesw47 in reply to Purpleazalia]

Thankyou....I;ve sent the links onto my sister.

[Cliff_G]

Go to aorticdissectionawareness.o... and scroll down to Visiting the Dentist. In particular the Scottish clarification of NICE wording, which has been endorsed ny NICE.

[francesw47 in reply to Cliff_G]

Thankyou. I've sent the links onto my sister - but the Scottish guidelines make it pretty clear.

[BigMel]

Hi francesw47,

Anyone who has had any form of surgery on their heart should make their dentist aware of their situation and insist on prophylaxis anti-biotics. If they refuse to give them, walk away and find another dentist who will give them.

Although the risks of getting it are small, Endocarditis is a killer and if you survive, it will cause chronic life changes.

Unfortunately, a lot of dentists have got used to the previous guidelines of not giving anti-biotics under any circumstances in the belief that they provide no cover at all. This is wrong and very dangerous.

This links below will help.

The last one is to a lecture from Dr David Carr who is an expert in the diagnosis of Endocarditis. THIS IS A MUST WATCH.

bjgpopen.org/content/1/1/bj...

nature.com/articles/sj.bdj....

youtube.com/watch?v=Wvjx3cx...(Not working as expected?)

Don't take no for an answer.

[Digger0 in reply to BigMel]

I told my dentist I'd had my ASD repaired, and booked a check-up after 6 months post op. He asked what the implant/repair was and I said titanium. He said I was OK without AB cover.

[francesw47 in reply to Digger0]

Interesting variation between dentists! Thanks for the info.

[BigMel in reply to Digger0]

I would get a letter from your Cardiologist and also show him the latest NICE guidelines and tell him that you want the antibiotics.

I don't think Endocarditis cares what it attaches itself to or what it's made of and I think the risk, however small is not worth saving 50p on antibiotics for. As for the overuse of antibiotics, you would have a hell of a lot more in hospital should you become infected.

[Anon2023 in reply to BigMel]

hi. Thank you so much for uploading this video. I can now see all of the opportunities that doctors lost before diagnosing me with endocarditis. It’s scary but everyone with heart problems should see this video and familiarise themselves with what doctors should be doing. Thanks again.

[BigMel in reply to Anon2023]

Your welcome.

[francesw47]

Thankyou. I've sent the links from others onto my sister. I'll forward the link to the Youtube video. Fortunately my dentist has always prescribed Amoxycylin so I'm covered. Endocarditis is indeed a nasty infection - my father had it many years ago and had to have his mitral valve replaced as a result. The NICE guidelines are becoming clear..and the situation of people with prosthetic valves vis a vis dental tratment equally so. I suspect its not the valve itself that could cause the problem but the scar tissue where the bacteria could colonise. Thanks for all replies..really helpful

[Anon2023]

hi. I had a battle with my dentist who said that I didn’t need antibiotics for dental treatment. I have a mechanical mitral valve and I had endocarditis 18 months ago. Despite this, the dentist kept quoting NICE guidelines although I think they had misinterpreted them. I refused treatment without antibiotics and sought advice from my cardiology nurse. My cardiologist wrote to the dentist saying it would be reckless not to use antibiotics and that I was in an high risk group. Although the dentist wasn’t happy I now get them before dental treatment/cleaning. Having survived endocarditis once I would not take any risks whatsoever and if the dentist is being awkward ask your sisters cardiologist to write to them. No dentist is going to go against the advice of a cardiologist, it would mean the end of their career if anything went wrong. Good luck.

[francesw47 in reply to Anon2023]

Thankyou.

[junik53]

Is having a stent classed as having surgery on the heart,and would the guidelines talked about here be applicable?

[Miocardial_1 in reply to junik53]

Hi, yes they would. I had a heart attack and stents in December. I had a dental check up and hygiene 2 weeks ago and they gave me antibiotics as per guidelines.

[junik53]

Thanks for your prompt reply . I had dental surgery to have a tooth removed and was done at a hospital as I was having sedation and they said I had to have it done in hospital as I had previously had a heart attack ,so they knew my history ,but at no time was I offered antibiotics. Surgery went well and all is ok , but surely they know about these guidelines and should be following them?

[Hidden]

Scottish based - my husband is giving antibiotics by his dentist, he takes a high dose pre treatment, he had mitral valve repair 3 yrs ago, 2 cardiac arrests, ICD and now end stage heart failure - his dentist (NHS) has been fantastic, he phoned my husband’s cardiologist and cardio thoracic team and checked it all out with them

[Exie8]

Our dentist has advised antibiotic prophylaxis one hour before any invasive/sub gingival dental treatment (including hygienist treatment) and discussed this with his cardiologist. A new prescription is handed over after each visit to the hygienist for the next visit.

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

[WestCorkHeart]

Hi, I had an Aortic Dissection and Aorta Valve Replement in August 2019. I was unfortunate to contract Endocarditis combined with Encephalitis and Menengitis in July 2022 whilst visiting family in Birmingham. Thanks to excellent care and complex surgery at QE Hospital I somehow survived. There was no evidence of the origin/cause of the infection.

I have been reluctant to have any dental treatment despite my wife being a dentist. However, my cardiologist strongly recommended in my review last week that I take extreme care with my dental health and take antibiotics with any treatment. In her professional and personal capacity my wife strongly supports this view.

[francesw47 in reply to WestCorkHeart]

I have learned a lot since I began this 'heart journey' nearly 10 years ago. The link between oral health and heart health is pretty clear so I pay strict attention to my oral health now. What astonishes me from the replies is that there is such difference between dentists. I do not like taking antibiotics. Overprescribing has led to a difficult situation with regard our ability to fight infections and the rise of hospital 'superbugs' worrying. However, from a personal perspective I would refuse treatment from a dentist who was not willing to prescribe prophylactic cover to patients who require it. Thankyou for responding and I hope that you have now fully recovered.

[Issy14]

Hello from New Zealand. My hygienist won't give me any treatment unless I have had my antibiotics. I have arranged that when they notify me of another appointment they automatically send me a prescription straight to my desired pharmacy - no hasstles.😀

[keeper1]

I had a mitral valve replacement in 2018, my dentist always prescribed Amoxicillin, but he retired last December, and my new dentist advised me to seek medical advice as new guidelines suggest they're not required also told me they are no longer allowed to issue prescriptions.

After contacting my consultant he replied that I do need the Amoxicillin.

Contacted the GP and explained the predicament and issued the prescription.

Trust this helps

[BigMel]

You shouldn't have to go to your GP, the dentist is the professional responsible should be made aware of the up to date NICE guidelines and not rely on what he was taught at dental school.

Frankly he is talking out of his posterior and needs to be re-educated before he causes someone chronic harm or death!

[Michaelkbrown]

Hello ,

I understand your concerns regarding antibiotic prophylaxis for dental treatment, especially after your sister's recent aortic valve replacement. Unfortunately, the NICE guidelines have changed, causing confusion and inconsistency among healthcare professionals. However, I'm here to provide you with some information that might help.

Please note that it's always best to consult your sister's cardiologist or dentist for the most up-to-date and personalized advice.

Historically, antibiotic prophylaxis was recommended for individuals at high risk of infective endocarditis (IE), such as those with certain cardiac conditions, including aortic valve replacement. However, recent guidelines have shifted towards a more selective approach due to concerns about antibiotic overuse and potential side effects.

Under the previous guidelines, the antibiotic cover was recommended for dental procedures involving gum tissue manipulation or oral mucosa perforation. The aim was to prevent bacteria from entering the bloodstream, potentially causing an infection on the artificial valve.

It's worth noting that while the NICE guidelines serve as a valuable resource, individual circumstances may vary, and personalized recommendations might differ. The ultimate goal is to strike a balance between preventing infection and minimizing it. Alternatively, you can contact your local dental clinic(urbansmilesvictoria.com/) or NICE directly. Dental clinics often stay informed about the latest guidelines and can provide accurate information based on their professional knowledge and experience.