Dentist's Reaction to my CRT-D

I went to my dentist's office this afternoon for a routine cleaning. When I told the hygienist about my new CRT-D she consulted the dentist about how to proceed and the dentist said I must be pre-medicated before any dental procedure for the next two to five years. Now I have to take 2000 mg of Amoxicillin one hour before I go to the office.
This all happened in Texas in the USA. If you have had similar reactions, I'd like to hear your story and country.
Thanks

I'd like to add that this club has been very helpful.

12 Comments

Dentist

by Grateful Heart - 2014-06-05 11:06:16

I didn't need pre-medication for my CRT-D but some Dentists or Cardios do require it.

Since my hip replacement a year ago, the Ortho told me I will always need to take the same as you, 2000 mg. of Amoxicillin 1 hour before the visit. When they call to remind me of the appt., they also remind me to take the pre-meds too which is great because I forgot last time.

If your Dentist uses a Cavitron (the ultra sonic tool) for cleaning your teeth, Boston Scientific told me to have the cable hang under the chair and not across your body so that there is no interference with your PM/ ICD.

Grateful Heart

Indication for endocarditis prophylaxis

by golden_snitch - 2014-06-06 02:06:14

Hi!

If the cardiac rhythm device is the only reason your doctors prescribe those antibiotics before a dental procedure - you have no artificial valve, no complex congenital heart defect, no prior history of infective endocarditis etc. -, then they are not sticking to the AHA guidelines at all. Here's a nice summary of these guidelines that will teach you that pacemaker and ICD patients are considered "low risk" patients for whom antibiotics have NEVER been recommended:

"Guidelines for antibiotic prophylaxis:
In the past, American Heart Association guidelines recommended that most patients with a heart murmur receive antibiotics prior to almost any dental procedures, even minor ones. However, these guidelines have changed considerably over time as more information has become available about the actual risk of dental procedures for patients with heart conditions. Review of studies performed between 1950 and 2006, which included thousands of patients, has shown that there was no benefit of using preventive antibiotics, except in the highest risk patients [1].

Highest risk:
People with the following conditions are considered to be at the highest risk of developing IE. Preventive antibiotics are generally recommended for people with the following conditions before certain procedures:

- A prosthetic heart valve.

- Valve repair with prosthetic material.

- A prior history of IE.

—Many congenital (from birth) heart abnormalities, such as single ventricle states, transposition of the great arteries, and tetralogy of Fallot, even if the abnormality has been repaired. Patent foramen ovale, the most common congenital heart defect, does not require prophylaxis.

The list of procedures that require pretreatment with antibiotics is available below. (See 'Antibiotic recommendations' below.)

Moderate risk:€” People with the following conditions are considered to be at moderate risk of developing IE. Antibiotic prophylaxis is NOT generally recommended for people with moderate risk conditions. This is an important change from prior recommendations [1].

- Valve repair without prosthetic material.

- —Hypertrophic cardiomyopathy.

- Mitral valve prolapse with valvular regurgitation and/or valvular thickening.

- —Most other congenital cardiac abnormalities not listed above.

- —Unrepaired ventricular septal defect, unrepaired patent ductus arteriosus.

- Acquired valvular dysfunction (eg, mitral or aortic regurgitation or stenosis).

- —Atrial septal defect, ventricular septal defect, or patent ductus arteriosus that was successfully closed (either surgically or with a catheter-based procedure) within the past six months.

Low risk: People with the following conditions are thought to have a low risk of IE. Antibiotics have never been recommended for people with these conditions:

- Physiologic, functional, or innocent heart murmurs.

- Mitral valve prolapse without regurgitation or valvular leaflet thickening.

- —Mild tricuspid regurgitation.

- Coronary artery disease (including previous coronary artery bypass graft surgery).

- —Simple atrial septal defect.

- Atrial septal defect, ventricular septal defect, or patent ductus arteriosus that was successfully closed (either surgically or with a catheter-based procedure) more than six months previously.

- Previous rheumatic fever or Kawasaki disease without valvular dysfunction.

- People with pacemakers or defibrillators.

Dental care recommendations:€” Anyone who is at risk of developing IE should follow a program of careful mouth and tooth care. This includes a professional cleaning every six months, twice daily tooth brushing, and once daily flossing. These measures can help to prevent plaque and bacteria from building up around the gums and teeth." http://www.uptodate.com/contents/antibiotics-before-procedures-beyond-the-basics

More links:

http://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis

http://circ.ahajournals.org/content/116/15/1736.full

If you take antibiotics too often, you might develop a resistance, so that when you REALLY need them, they no longer work. Therefore, be careful with any antibiotics that are not necessary.

Inga

Yes...

by golden_snitch - 2014-06-06 06:06:15

Hi Don,

yes, we have the same guidelines here. They changed them pretty soon after the AHA. But the thing is: Pacemaker and ICD patients have NEVER been in the group that's supposed to get prophylactic antibiotics, not even in older guidelines. It really is a shame when doctors urge ICD/pacer patients (without any other issues, like artificials valves etc.) to take antibiotics. There is absolutely no basis for this - not now, and not in the past. I would even go as far as saying it's grossly negligent, because they risk that their patients develop an antibiotic resistance. And we all know that there are diseases where we really, really need those antibiotics to work.

Sorry that I didn't reply to your private message, yet. I'm happy to hear that your SOB seems to have been caused by the hernia, and that you are now doing much better. Hope you continue to recover well and quickly!

Inga

Thanks, Inga.....

by donr - 2014-06-06 06:06:29

.....for publishing all that. I've always wanted to see it, but was too lazy to search it out! There was a time when I had to take the antibiotic an hour before, also, but that changed at least 5 yrs ago.

OK, so you mention the AHA - what is its applicability to the rest of the World? Are those guidelines pretty much universal? Been adapted by the Euro Union?

Don

Hi Giacomo.........

by Tattoo Man - 2014-06-06 06:06:57


.........Inga...as ever...is spot-on with her information.

I had a replacement tissue Aortic valve in '07 and the rule was, here in the UK, 3000mg..repeat 3000mg of Amoxicillin before any dental treatment, including cleaning.

Even back then my Dentist, Steve , told me that this was a long standing insurance issue that no one in the profession gave any credence to.

About five years ago this antibiotic 'Cover' rule was abandoned as a result of inadequate evidence in its favour.

So, I no longer am required to overdose on Amoxicillin for routine dental work...I am only required to stop taking my daily 150mg of Aspirin to prevent blood loss were I to need an extraction.

I do however,.always keep a 3 gram sachet of Amoxicillin and also a 21 day course of 500mg. This way if I am on holiday or feel a tooth twinge I can get ahead of the problem before seeing my Dentist.

So...its all about insurance and potential litigation, based on archaic and unsubstantiated evidence.

There is clear evidence that dental hygiene and cardiac health are connected but this is in-extremis, usually connected with poor dental hygiene.

The simple message is....keep your teeth clean and get regular check ups.

Best wishes.

Tattoo Man

Pacemakers and risk of bacterial endocarditis.

by Selwyn - 2014-06-06 08:06:20

The short answer is there is not a significant risk.
No antibiotics are required for dental procedures if you only have a pacemaker/ICD. This includes having dental implants.

Are you to take an antibiotic every time you brush your teeth?

If you want to see a readable view try:
http://www.patient.co.uk/doctor/prevention-of-infective-endocarditis#ref-1

Show this to your dentist- there is a greater risk in having the antibiotics than in getting an endocardial infection.

stubborn den tists

by Tracey_E - 2014-06-06 09:06:26

ADA changed their guidelines after AHA, but they both changed it years ago. When AHA first changed their recommendations, my cardio had to call my dentist to convince him it was ok. Maybe your dr could call your dentist? I would not quietly take it. As Inga said, overuse of antibiotics is not good for many reasons. JMHO, but if it's not crucial, I'm going to dig in my heels and say no.

The bottom line here is

by Grateful Heart - 2014-06-07 10:06:28

the Dentist is looking out for you. He is trying to do right by you. When I got my ICD, my Dentist requested my Cardio put in writing that I did not need to be pre medicated before any dental procedures, including cleaning.

He did and the note is in my dental chart. Yes, it is also partly CYA for the Dentist but I think he would feel terrible if he didn't have that assurance and something happened. I really like my Dentist (new rumor) and he was genuinely concerned.

Again, in my case, I have to take the pre meds now anyway since the hip replacement so that note no longer applies.

So just ask your Cardios to be sure and then something in writing should place your Dentist at ease....for you and for him.

Grateful Heart

Interesting discussion...

by donr - 2014-06-07 11:06:03

...especially the history lesson from Inga. I got caught in the period when AHA & ADA differed in their guidelines. Being fat, dumb & happy, just took what the dentist told me to take - did not know enough to resist., so I took some whopping doses of some antibiotics. For some reason, I recall my Cardio being complicit in the situation.

Right now I am known to be allergic to Penicillin & its close relatives, courtesy of a rash I developed following a dose back in the early 60's. Suspected allergic to Levoquin, Cipro, Erithromycin & their close relatives to the point that no one will chance a major reaction. When I caught that Pneumonia it was a tough call for what to give me.

Donr

did not know

by judyblue - 2014-06-07 12:06:11

I never questioned the dentist requiring the antibiotics. He will be getting a lesson from me next time! I agree that the overuse of antibiotics is dangerous. thank you for this invaluable info.
judy

Don..........

by Tattoo Man - 2014-06-08 06:06:03


.................it aint the penicillins that you need to be scared of...

Just those Bears ,..hangin round your screen door;...

TM UK

More About Dentist

by Giacomo - 2014-06-09 07:06:17

My dentist has now agreed that a written statement from my cardiologist that the pre-medication antibiotic dose is not necessary is enough for her.

Thanks to all of you who took time to share your thoughts about this issue.
Giacomo

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