antibiotics for dental work

[saris]

Ive heard about this but dont know too much about it. When should I pre medicate before dental work? Or should I? If anyone knows about this please let me know. Ive only been diagnosed with HCM for a few months, so Im just learning. Thanks, Mike

[mandksiders]

I think most people on this board will recommend having a strong dose of antibiotic an hour or two before any dental work. I believe it's so you can prevent an infection to the heart that may result from the bacteria or germs that can come from your mouth during dental work. That bacteria can travel to the heart through the bloodstream and attach to damaged heart tissue or abnormal heart valves. There might be more that could happen as well, but I think that's the gist of it.

I just call my family doctor a couple of days before my appointments and she calls in a prescription for me. My dentist will also call one in for me as well if needed- he will not work on my teeth unless I have taken the medication beforehand.

I think anyone with HCM should have an antibiotic before any dental work...it's better to be safe than sorry.

[gfox42]

I agree. The consensus among HCM specialists is currently to medicate.

All I had to do was mention it to my dentist; he writes me a prescription. He says (wisely, I think) "I leave this up to the cardiologists." In fact, when his office calls me to remind me about appointments, they always remind me to premedicate. Not all dental offices are so easy about this, I'll bet, but if you talk to your dentist they may well do the right thing.

Gordon

[j1plante]

My HCM specialist recommends NOT taking antibiotics prior to dental work, citing the American Heart Association statement that came out in April 2007.
http://www.americanheart.org/presenter.jhtml?identifier=3047083

This sums it up: However, the drugs [antibiotics carry risks, including fatal allergic reactions and possibly making the bacteria that cause IE [infective endocarditis] to become resistant to antibiotics. Although allergic reactions are minimal, new evidence shows the risks outweigh the benefits for most patients receiving these antibiotics.

Last year I had a dentist refuse to give me dental work, despite these recommendations as of 2007, because of my HCM and my refusal to not take antibiotics.

[eric3729]

Recently diagnosed and recently met with Dr. Lever and Smedira on this issue among others....both indicated a strong recommendation that premedication for any dental work is a must

[Jillmgk]

We were told this summer that my son does not need prophylactic meds for dental work. Its probably a case by case basis for those decisions....

[Gayle07]

I'm amazed at the many different resonses to this post. I was told before I had the surgery that I had to pre-med for the dentist but then my dentist said some new rules came out from the AMA in 2007 and it was not longer being mandated. I have a cleaning twice a year and so this much antibotic doesn't seem like a good idea anyhow especially if I'm only growing resistant to it anyhow with such regular use. I asked my cardio about it and he too said it was no longer being considered a MUST DO requirement.

[Bruce42]

At the 2007 HCMA meeting, I felt sorry for the poor doctor who came to explain the new AMA policy not to require premedication. Almost every other member of the medical panel at the meeting (the dozen or so leading HCM specialists in the country) strongly disagreed and recommended continuing to premedicate.

In 2006, I had the unpleasant experience of becoming bacteremic--i.e., having a bacterial infection in my bloodstream. I have never felt sicker, faster, in my life. At dinner I was fine, an hour later I had a high fever, chills, and severe aches in my bones, by the morning I could barely move. The ER doc in the small town I was visiting wanted to give me a spinal tap; she thought I had meningitis. Fortunately I got back to DC, got a blood culture, and was diagnosed and immediately hospitalized--to be put on IV antibiotics and watched for bacterial endocarditis. Fortunately, my treatment was prompt enough that I had no damage to my valves, and I was out in 4 days--though I had to continue on IV antibiotics for a month. (They can send you home with that now--you don't have to be hospitalized for a month, like my father did 40 years ago.)

Here's the question every doctor and nurse asked me through that experience: "When did you have your dental work?" The funny thing is, I didn't. It was apparently random; they never figured out how I got the infection. (One doctor guessed maybe flossing, and suggested I use a water-pik instead. Another guessed maybe from crab shells--my dinner right before getting sick was a Maryland crab picking.) But I gathered that ending up this way from dental work is not uncommon.

My takeaway from the experience is that even if the chance of a blood infection is rare, the magnitude of harm if it happens is severe. Someone I work with who manages risk for a living said their expression is, "the canyon is narrow but it is deep." So although I appreciate the public health problems that can come from overuse of antibiotics generally (and I try to avoid using them when I can in other situations--e.g., no antibacterial soaps, factory-farmed meat, or demanding antibiotics for every ache and sniffle), I do not ever skip them for dental work anymore. Nor does my dentist.

[hocmdoug]

I was told to pre-medicate. I can see both sides of the argument (I sound like a politician:rolleyes:).