Dentist

I saw my dentist for a routine cleaning last week and, after updating my medical history, they refused to clean my teeth. I was told the cardiologist must fax permission to the dentist and state whether I need antibiotics prior to dental procedures. Is this unusual? My doctor never mentioned it.

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My dentist won't touch my teeth without calling in antibiotics first. This started after my second stent. I have been told that while rare, plaque from the teeth that comes off during the cleaning that you inadvertantly swallow can somehow make some wild and crazy journey through your blood stream into your heart. Not sure how antibiotics prevent this. I have learned to call the dentist a few days before my appointment and have them call in my antibiotics. It is usually just a few pills to take the day before. It is easier to just take them than to have to get cardio clearance every time I go in.

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I found this info http://www.mayoclinic.com/health/endocarditis/DS00409.

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Great information Joy. Thanks for sharing. However, the period in the link is throwing it off. When you click on it, it says page not found. I searched the site under endocarditis and found the article and the link is exactly as you typed - minus the period.

http://www.mayoclinic.com/health/endocarditis/DS00409

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Thwarted by my penchant for punctuation. Drats. Thanks for the fix! :-)

Karla

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They started this new procedure for teeth cleaning if you had heart, lung, and other major problems you had to take 4 500 mg tablets a hour before procedure that was three years ago. Then when I went last year to the dentist he said I didn't have to do it anymore unless I had a stent put in my heart which I didn't. On the other hand my husband has blood clotting disorder and he is on coumodin so he has to take the antibiotic before he gets teeth worth done for anything. So who knows for sure what they are doing.

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Hi Ladies,

For those of you who donate blood, you may have noticed you are questioned whether you have had ANY dental work 2 days prior to donating. Even dentists cleaning the teeth can release a flood of bacteria into the bloodstream. The research findings on this have been circulating for years.....I had my first root canal 5 days before acute MI. My dentist was properly proactive when I mentioned I'd had a HA at the start of the next dental visit.....he stopped dead, "Wow, You're way too young for that. Just to be safe I want to call your cardio re antibiotics before we begin this procedure." My dr (old school) told him no meds needed. This was the same doc who never even mentioned cardiac rehab to me, told me "you have nothing to be depressed about" when I mentioned I was having a dreadful time finding even the will to get up and move or eat.

At the time, I was still a raw and uninformed, stunned heart attack recovery newby and had never heard of the dangers of dental messing around being connected with possible heart attacks and strokes.

take care everyone,
Jaynie

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All,
I have taken antibiotics prior to all dental cleanings and work for the past 35 years, thanks to having had rheumatic fever as a child. In the past year of so, just prior to my MI, they have changed the recommendation and no longer suggest antibiotics. (medical studies supposedly show it doesn't make a difference.)

So this year I have had root canal, crown, filling and cleanings all done without antibiotics the first time in my adult life - all since my MI when my heart is most vulnerable. Go figure!

The dentist says it is not necessary, the cardio and famly doc agree. But the dentist does say if it would make me feel better he will continue to prescribe them for my dental work. I figure the less pills I absolutely need the better.

I hope this makes sense,
Laura

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Also, forgot to mention this is common practice to use antibiotics before dental work if you have had implants for the first year or so - knee, hip, etc. to keep them protected as well.

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Found this information on the recent change in procedures -- from the American Heart Association website.

http://www.americanheart.org/presenter.jhtml?identifier=3047051

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I have been on antibiotics for dental work and other incidents where my doc was concerned about bacteria getting into my blood (once I ripped the nail off my big toe) ever since my first open-heart surgery at the age of 25. I was born with a hole in my heart and I needed my mitral valve repaired.

Despite that, I developed flu like symptoms on Christmas day 1998. After one month of trying to treat the flu, my internist found I had endocarditis. I had been to the dentist the week before Christmas but the antibiotics I had taken did not cover me. This resulted in 2 weeks in the hospital, a month on IV antibiotics and I still needed open heart surgery to replace 2 of my valves six months later.

Now I get 2 meds via IV antiobiotics administered by a nurse who comes to my house before every dental appointment. Stats suggest once you've had endocarditis you are at higher risk of getting it again.

My suggestion: criteria has changed and now fewer people require antibiotics. History has suggested we over medicated and that's resulted in super bugs evolving. Discuss and follow whatever your doc suggests for you. Also, if you ever get a high fever and chills and you've been to the dentist recently, ask for a blood culture before you take any meds to make sure you don't have endocarditis. This has happened to me twice since my second open-heart surgery in '99. Cultures are expensive but heart infections are deadly.

Also, because I'm a high risk patient, I checked around and now am a patient of a brilliant, compassionate dentist. I dumped a dentist who botched TWO root canals! We need to be our own best advocate and with a little bit of effort we can receive optimum care which we deserve.

That said, God's in charge no matter what we do. In 2001 I had a random ache in my side for 2 weeks. My doc found I had been walking around with a burst appendix and my body walled off the infection. I was pickled in antibiotics to the tune of $250,000 and then after the infection was cooled off, they went in a took out my appendix. My doc sat at the end of my bed and said, "You really should be dead!"

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Thanks to everyone...I really appreciate all the feedback.
I'll mention it to the cardiology nurse when she calls with results of an ultrasound I had last week concerning soreness and swelling which developed recently at the puncture site for the angiogram. The procedure was 3 months ago.

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Dear Tristan,
Apparently this december the rules changed about having to pre-medicate when going to the dentist. I always had to and then after my MI in february I had to have my cleaning and I was told by both my dentist and Cardiologist that only in certain situations did you have to pre medicate. One of them is if you have a pacemaker/defibrilator. Then I heard someone recently say that her dr. insists that she still be pre-medicated regardless, the fact that she has heart disease means that she shouls be pre medicated. I think it's going to end up being a person by person decision. If you feel safer with the antibiotic by all means I would ask the dr for it. I have an aquaintance that I recently met and she ended up having her aortic valve replaced due to an infection she got after having dental work , she was literally bed ridden and the dr's kept telling her that she had the flu. well, finally when she was not getting any better they hospitilized her and told her that the infection in her body had destroyed her heart valve, she was in the hospital a month. Her dr. insists that because of this she be always medicated before going to the dentist. Since her story I'm very leary about not being pre-medicated. You have to use your judgement and ask yourself if the procedure is something that can potentially give you a problem or not. Definitely speak to your dr and let them know your concerns A cleaning is probably not a big deal but extensive and ongoing dental treatment is another.
Good luck,
Sandy

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Hi Rudywg,

Ok, you just won first prize for most medical incredible tale I've read here !!!! : ) And how astonishing that your body reacted so swiftly to wall off the damage and maybe saved your life in its own way. Try to stay out of trouble for a while. You need a break! (smile)

martzj

....... My doc found I had been walking around with a burst appendix and my body walled off the infection. I was pickled in antibiotics to the tune of $250,000 and then after the infection was cooled off, they went in a took out my appendix. My doc sat at the end of my bed and said, "You really should be dead!"

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Rudy & Jaynie,
(Jaynie - Add this to your list of " Anything with a twist that can happen seems to have happened to Dianna/gracie62")
Glad to know I am not the only one who had an episode of antibiotic supressed appendicitis. Fortunately, mine did not burst. In 1984 just after graduation from high school I developed severe pain in my side. I was hospitalized and checked head to toe, supposedly. Pumped full of antibiotics and told I had a severe urinary tract infection. Went to the doctor monthly and basically kept on antibiotics for 6 months for a "UTI". After being off the antibiotics for about 2 weeks, I was rushed to the hospital for an emergency appendectomy. I was told I was teetering on the edge of it bursting, but the infection was contained in the appendix. I was told there was no way this had come up suddenly - all the antibiotics I had been on had supressed it. Yes, Jaynie - this happened to me - I swear! I was living in Austin at the time, 19 years old away from home for the first time and newly married. In fact, I had just been married 20 days before and met my husband upon his return from a trip at the airport begging him to make the pain stop.

I have been avoiding a trip to the dentist myself since I had open heart 12/30/07. I guess it is a safe bet that I will need antibiotics. When they numb my mouth for any work, I look like a victim of domestic violence for weeks due to the Plavix. Still, I know it will only be worse the longer I wait. This topic has reminded me of that dreaded call I really need to make. And I saw the movie The Dentist III on Chiller network today - Yikes!
Take care, everyone -
Dianna

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Good grief Dianna,

Yep, you get added to the bizarre medical tales list fer sur!!! How can you stand those dental horror flicks...eek.

You try to stay out of trouble today too!!! (smile)
Jaynie

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What a great topic. I've had a prolapsed mitral valve since childhood but only have taken Penicillin prior to dental work for about 20 years or so. Just this past year they changed the protocol for dental work prophylaxis and only in certain situations is it required, one of those being valve replacement which I have not had.

There, however, has been much research about the
connection between the inflammation in the heart vessels and the inflammation in periodontal disease so many dentists and cardiologists are now collaborating much more actively about advising patients to see their own doc if either is present.

Since I'm an NP I have seen this in journals. I've also asked my own cardiologist and dentist now that I'm a post by-pass patient and on their advice I no longer take my antibiotics. But from what all of you have written, there is still much going on out there that I know NOTHING about.

Thanks for being educators for all of us! We need each other - as we all already know!

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I do have a pacemaker now so guess it was good the dental assistant didn't clean my teeth. Also, still have a problem at the puncture site for the angiogram. Hope cardiologist calls with results of ultrasound as vacation time is just around the corner...but, what the heck-- they have good medical facilities where we're going.

Really is nice to have a list like this to hear about other people's experiences.

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i worked for a dentist for thirteen years and that was standard procefure for all patients with a valve replacement. i know it is maddening but it really is for your benefit. the dentist or front office girl could have been more helpful and let you know why. good luck joan

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Hi Tristan,

You might want to get that puncture site looked at, especially if it is oozing, stays blue-black bruised too long. I''m thinking your post op care instruction will include what steps to take in case of wound not healing.

take care,
martzj

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Appreciate the heads up. The post-op instructions did say to contact the doctor in the event things like this happen so I called them first thing last Monday as I didn't want to bother them on the weekend with a non-emergency.

The puncture site did began oozing today and there's more redness. Although I didn't press very hard, the lump feels like it's almost gone. I reported this to the doctor and have an appointment for tomorrow. That will also give me an opportunity to relay the Dentist' s request for permission to clean my teeth. Anxious to see what, if anything, they'll do, about the puncture site.

Thanks guys.

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