Re: antibiotics prior to dentist appointment

[Guest guest]

When in doubt dentist's recommend antibiotics.

The purpose of antibiotics is to prevent heart valve infections. If

there is a heart murmur on exam or abnormal valve on echocardiogram

then antiboitic are valuable.

If a dentist is asked about antibiotic after transplant it is easier

to give antibiotics than to look up a patient's medical record and

look at the latest guidelines.

Here is information about the guidelines:

http://www.clevelandclinicmeded.com/diseasemanagement/infectiousdisease/prophyla\

xis/prophylaxis.htm

http://216.185.112.5/presenter.jhtml?identifier=4436

I don't see special mention of immunosuppression.

Here is an article about the habit of giving antibiotic when in doubt:

Antibiotic prophylaxis for endocarditis: time to reconsider.

Aust Dent J. 2005; 50(4 Suppl 2):S60-8 (ISSN: 0045-0421)

Singh J; Straznicky I; Avent M; Goss AN

Oral and Maxillofacial Surgery, Faculty of Health Sciences, The

University of Adelaide.

Some cardiac conditions require antibiotic prophylaxis for some types

of dental treatment to reduce the risk of infective endocarditis (IE).

All medical and dental practitioners are familiar with this practice

but tend to use different regimens in apparently similar

circumstances. Generally, the trend has been to prescribe antibiotics

if in doubt. This review explores the evidence for antibiotic

prophylaxis to prevent IE: does it work and is it safe? The changing

nature of IE, the role of bacteraemia of oral origin and the safety of

antibiotics are also reviewed. Most developed countries have national

guidelines and their points of similarity and difference are

discussed. One can only agree with the authority who describes

antibiotic guidelines for endocarditis as being 'like the Dead Sea

Scrolls, they are fragmentary, imperfect, capable of various

interpretations and (mainly) missing!' Clinical case-controlled

studies show that the more widely antibiotics are used, the greater

the risk of adverse reactions exceeding the risk of IE. However, the

consensus is that antibiotic prophylaxis is mandatory for a small

number of high-risk cardiac and high-risk dental procedures. There are

a large number of low-risk cardiac and dental procedures in which the

risk of adverse reactions to the antibiotics exceeds the risk of IE,

where prophylaxis should not be provided. There is an intermediate

group of cardiac and dental procedures for which careful individual

evaluation should be made to determine whether IE or antibiotics pose

the greater risk. These categories are presented. All medical and

dental practitioners need to reconsider their approach in light of

these current findings.

Subject Headings

Major Subject Heading(s) Minor Subject Heading(s)

* Antibiotic Prophylaxis [standards]

* Cost-Benefit Analysis

* Dental Care [adverse effects]

* Endocarditis, Bacterial [prevention & control]

* Endocardium [microbiology]

* Humans

* Practice Guidelines

* PreMedline Identifier: 16416720

[Guest guest]

When in doubt dentist's recommend antibiotics.

The purpose of antibiotics is to prevent heart valve infections. If

there is a heart murmur on exam or abnormal valve on echocardiogram

then antiboitic are valuable.

If a dentist is asked about antibiotic after transplant it is easier

to give antibiotics than to look up a patient's medical record and

look at the latest guidelines.

Here is information about the guidelines:

http://www.clevelandclinicmeded.com/diseasemanagement/infectiousdisease/prophyla\

xis/prophylaxis.htm

http://216.185.112.5/presenter.jhtml?identifier=4436

I don't see special mention of immunosuppression.

Here is an article about the habit of giving antibiotic when in doubt:

Antibiotic prophylaxis for endocarditis: time to reconsider.

Aust Dent J. 2005; 50(4 Suppl 2):S60-8 (ISSN: 0045-0421)

Singh J; Straznicky I; Avent M; Goss AN

Oral and Maxillofacial Surgery, Faculty of Health Sciences, The

University of Adelaide.

Some cardiac conditions require antibiotic prophylaxis for some types

of dental treatment to reduce the risk of infective endocarditis (IE).

All medical and dental practitioners are familiar with this practice

but tend to use different regimens in apparently similar

circumstances. Generally, the trend has been to prescribe antibiotics

if in doubt. This review explores the evidence for antibiotic

prophylaxis to prevent IE: does it work and is it safe? The changing

nature of IE, the role of bacteraemia of oral origin and the safety of

antibiotics are also reviewed. Most developed countries have national

guidelines and their points of similarity and difference are

discussed. One can only agree with the authority who describes

antibiotic guidelines for endocarditis as being 'like the Dead Sea

Scrolls, they are fragmentary, imperfect, capable of various

interpretations and (mainly) missing!' Clinical case-controlled

studies show that the more widely antibiotics are used, the greater

the risk of adverse reactions exceeding the risk of IE. However, the

consensus is that antibiotic prophylaxis is mandatory for a small

number of high-risk cardiac and high-risk dental procedures. There are

a large number of low-risk cardiac and dental procedures in which the

risk of adverse reactions to the antibiotics exceeds the risk of IE,

where prophylaxis should not be provided. There is an intermediate

group of cardiac and dental procedures for which careful individual

evaluation should be made to determine whether IE or antibiotics pose

the greater risk. These categories are presented. All medical and

dental practitioners need to reconsider their approach in light of

these current findings.

Subject Headings

Major Subject Heading(s) Minor Subject Heading(s)

* Antibiotic Prophylaxis [standards]

* Cost-Benefit Analysis

* Dental Care [adverse effects]

* Endocarditis, Bacterial [prevention & control]

* Endocardium [microbiology]

* Humans

* Practice Guidelines

* PreMedline Identifier: 16416720

[Guest guest]

When in doubt dentist's recommend antibiotics.

The purpose of antibiotics is to prevent heart valve infections. If

there is a heart murmur on exam or abnormal valve on echocardiogram

then antiboitic are valuable.

If a dentist is asked about antibiotic after transplant it is easier

to give antibiotics than to look up a patient's medical record and

look at the latest guidelines.

Here is information about the guidelines:

http://www.clevelandclinicmeded.com/diseasemanagement/infectiousdisease/prophyla\

xis/prophylaxis.htm

http://216.185.112.5/presenter.jhtml?identifier=4436

I don't see special mention of immunosuppression.

Here is an article about the habit of giving antibiotic when in doubt:

Antibiotic prophylaxis for endocarditis: time to reconsider.

Aust Dent J. 2005; 50(4 Suppl 2):S60-8 (ISSN: 0045-0421)

Singh J; Straznicky I; Avent M; Goss AN

Oral and Maxillofacial Surgery, Faculty of Health Sciences, The

University of Adelaide.

Some cardiac conditions require antibiotic prophylaxis for some types

of dental treatment to reduce the risk of infective endocarditis (IE).

All medical and dental practitioners are familiar with this practice

but tend to use different regimens in apparently similar

circumstances. Generally, the trend has been to prescribe antibiotics

if in doubt. This review explores the evidence for antibiotic

prophylaxis to prevent IE: does it work and is it safe? The changing

nature of IE, the role of bacteraemia of oral origin and the safety of

antibiotics are also reviewed. Most developed countries have national

guidelines and their points of similarity and difference are

discussed. One can only agree with the authority who describes

antibiotic guidelines for endocarditis as being 'like the Dead Sea

Scrolls, they are fragmentary, imperfect, capable of various

interpretations and (mainly) missing!' Clinical case-controlled

studies show that the more widely antibiotics are used, the greater

the risk of adverse reactions exceeding the risk of IE. However, the

consensus is that antibiotic prophylaxis is mandatory for a small

number of high-risk cardiac and high-risk dental procedures. There are

a large number of low-risk cardiac and dental procedures in which the

risk of adverse reactions to the antibiotics exceeds the risk of IE,

where prophylaxis should not be provided. There is an intermediate

group of cardiac and dental procedures for which careful individual

evaluation should be made to determine whether IE or antibiotics pose

the greater risk. These categories are presented. All medical and

dental practitioners need to reconsider their approach in light of

these current findings.

Subject Headings

Major Subject Heading(s) Minor Subject Heading(s)

* Antibiotic Prophylaxis [standards]

* Cost-Benefit Analysis

* Dental Care [adverse effects]

* Endocarditis, Bacterial [prevention & control]

* Endocardium [microbiology]

* Humans

* Practice Guidelines

* PreMedline Identifier: 16416720

[Guest guest]

Ken’s

doctor gave him a scrip for antibiotics each and every time he was to have

dental work done. He doesn’t

have any problems with his heart. He did/does have ESLD so maybe that was

what made a difference.

Barb in Texas - Together in the Fight, Whatever it

Takes!

Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

__

[Guest guest]

Ken’s

doctor gave him a scrip for antibiotics each and every time he was to have

dental work done. He doesn’t

have any problems with his heart. He did/does have ESLD so maybe that was

what made a difference.

Barb in Texas - Together in the Fight, Whatever it

Takes!

Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

__

[Guest guest]

Ken’s

doctor gave him a scrip for antibiotics each and every time he was to have

dental work done. He doesn’t

have any problems with his heart. He did/does have ESLD so maybe that was

what made a difference.

Barb in Texas - Together in the Fight, Whatever it

Takes!

Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

__

[Guest guest]

Actually it is my hepatologist and not my dentist that said I needed

these antibiotics. My heart is fine and I have never had to take any

before I got the transplant so I thought it had something to do with

that.

Thanks for the atricle. I will take a look at it.

Pat (CA)

>

> When in doubt dentist's recommend antibiotics.

> The purpose of antibiotics is to prevent heart valve infections. If

> there is a heart murmur on exam or abnormal valve on echocardiogram

> then antiboitic are valuable.

> If a dentist is asked about antibiotic after transplant it is easier

> to give antibiotics than to look up a patient's medical record and

> look at the latest guidelines.

>

> Here is information about the guidelines:

>

http://www.clevelandclinicmeded.com/diseasemanagement/infectiousdiseas

e/prophylaxis/prophylaxis.htm

> http://216.185.112.5/presenter.jhtml?identifier=4436

[Guest guest]

I'm sorry I'm not up on all the abbreviations. What does ESLD stand for?

Pat (CA)

>

> Ken's doctor gave him a scrip for antibiotics each and every time he

was

> to have dental work done. He doesn't have any problems with his

heart.

> He did/does have ESLD so maybe that was what made a difference.

>

> Barb in Texas - Together in the Fight, Whatever it Takes!

> Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

>

> __

>

[Guest guest]

I'm sorry I'm not up on all the abbreviations. What does ESLD stand for?

Pat (CA)

>

> Ken's doctor gave him a scrip for antibiotics each and every time he

was

> to have dental work done. He doesn't have any problems with his

heart.

> He did/does have ESLD so maybe that was what made a difference.

>

> Barb in Texas - Together in the Fight, Whatever it Takes!

> Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

>

> __

>

[Guest guest]

I'm sorry I'm not up on all the abbreviations. What does ESLD stand for?

Pat (CA)

>

> Ken's doctor gave him a scrip for antibiotics each and every time he

was

> to have dental work done. He doesn't have any problems with his

heart.

> He did/does have ESLD so maybe that was what made a difference.

>

> Barb in Texas - Together in the Fight, Whatever it Takes!

> Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

>

> __

>

[Guest guest]

-----Original

Message-----

I'm sorry I'm not up on all the abbreviations. What does ESLD

stand for?

End Stage Liver

Disease.

The doctor that said Ken should

take antibiotics before going to the dentist was his GI.

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

_

[Guest guest]

-----Original

Message-----

I'm sorry I'm not up on all the abbreviations. What does ESLD

stand for?

End Stage Liver

Disease.

The doctor that said Ken should

take antibiotics before going to the dentist was his GI.

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

_

[Guest guest]

pej_jones wrote:

>

> I'm having my first dentist appointment since my transplant tomorrow

> and the doctor has told me that I need to take a large dose of

> antibiotics an hour before. ....

>

> ..... Has anyone had any problems

> from taking such a high dose?

Due to a heart murmur, my husband has to take antibiotics whenever he

has dental work. For years he was told to take the antibiotic 3 times a

day for 3 days (day before, day of, and day following the procedure).

Then, about 8 years ago, he was told to take only the one massive dose

an hour before the procedure. He ended up sick as a dog and I honestly

thought they were going to have to admit him to the hospital. It was

about 10 days before he was himself again. That was quite enough for

him! He will never again take a single massive dose. Our dentist has

no problem with his using the 3-day regimen.

Obviously, his situation is not a transplant situation and I cannot

speak to how much difference it might make. Listen to Aubrey's advice

-- take the pills and don't risk extreme complications.

Perhaps with your sensitive stomach, they could give it to you in an

injection?

Regards,

Carolyn B. in SC

[Guest guest]

I was at the dentist again last week and this topic was again addressed. My transplant team does not recommend antibiotics before dental procedures, and has written several letters to the dentists to confirm this. I am 4 years out from my tx and I'm doing well so that may be why he doesn't recommend them.

He also doesn't recommend taking any supplements except vitamins and calcium, when I asked about fish oil and glucosamine, he nixed both.

I am just as glad not to take extra antibiotics, I don't want to begin breeding resistant bacteria. Before my tx I had two bouts of pseudomonas, both happened 2 days after ERCPs, and I was on a variety of antibiotics. I was told that I had everything on the list and was lucky to still find one to work.

The dentist, on the other hand, prescribed penicillin as a follow up, she mentioned that since I was taking actonel, recently switched to boniva, she wanted me to take the antibiotic as a precaution. There has been some cases of jaw bone loss after tooth extractions and other dental surgery. It is rare, and when I brought it up, she explained things that I do not remember now.

Are the dentists contributing to the growth of resistant pathogens by prescribing antibiotics too often? I can certainly appreciate the need when there are heart valve problems etc, but it is an interesting issue we haven't addressed in awhile.

Take Care

MizKit

[Guest guest]

I was at the dentist again last week and this topic was again addressed. My transplant team does not recommend antibiotics before dental procedures, and has written several letters to the dentists to confirm this. I am 4 years out from my tx and I'm doing well so that may be why he doesn't recommend them.

He also doesn't recommend taking any supplements except vitamins and calcium, when I asked about fish oil and glucosamine, he nixed both.

I am just as glad not to take extra antibiotics, I don't want to begin breeding resistant bacteria. Before my tx I had two bouts of pseudomonas, both happened 2 days after ERCPs, and I was on a variety of antibiotics. I was told that I had everything on the list and was lucky to still find one to work.

The dentist, on the other hand, prescribed penicillin as a follow up, she mentioned that since I was taking actonel, recently switched to boniva, she wanted me to take the antibiotic as a precaution. There has been some cases of jaw bone loss after tooth extractions and other dental surgery. It is rare, and when I brought it up, she explained things that I do not remember now.

Are the dentists contributing to the growth of resistant pathogens by prescribing antibiotics too often? I can certainly appreciate the need when there are heart valve problems etc, but it is an interesting issue we haven't addressed in awhile.

Take Care

MizKit

[Guest guest]

I was at the dentist again last week and this topic was again addressed. My transplant team does not recommend antibiotics before dental procedures, and has written several letters to the dentists to confirm this. I am 4 years out from my tx and I'm doing well so that may be why he doesn't recommend them.

He also doesn't recommend taking any supplements except vitamins and calcium, when I asked about fish oil and glucosamine, he nixed both.

I am just as glad not to take extra antibiotics, I don't want to begin breeding resistant bacteria. Before my tx I had two bouts of pseudomonas, both happened 2 days after ERCPs, and I was on a variety of antibiotics. I was told that I had everything on the list and was lucky to still find one to work.

The dentist, on the other hand, prescribed penicillin as a follow up, she mentioned that since I was taking actonel, recently switched to boniva, she wanted me to take the antibiotic as a precaution. There has been some cases of jaw bone loss after tooth extractions and other dental surgery. It is rare, and when I brought it up, she explained things that I do not remember now.

Are the dentists contributing to the growth of resistant pathogens by prescribing antibiotics too often? I can certainly appreciate the need when there are heart valve problems etc, but it is an interesting issue we haven't addressed in awhile.

Take Care

MizKit

[Guest guest]

Below is a link to a thoughfull article on transplants and dental

prophalaxis from dental literature. Basically they suggest

1. In the post operative period 3-6 months invasive proceedures should

be avoided. Prophalatic antibiotic should be considered.

2. In the stable graft period. (after 3-6 months) Antibioitic should

be considered for

invasive proceedures.

3. In chronic graft rejection only emergency dental care should be

considered.

I'm not sure of the definition of invasive dental proceedures.

I'm not sure what they mean by " consider " but I think it means to

weight the pros and cons for an individual patient.

My apologies for the long link.

http://www.agd.org/library/2005/feb/Byron_151.pdf#search=%22Dental%20management%\

20of%20the%20(solid)%20organ%20transplant%20patient.%22

[Guest guest]

Below is a link to a thoughfull article on transplants and dental

prophalaxis from dental literature. Basically they suggest

1. In the post operative period 3-6 months invasive proceedures should

be avoided. Prophalatic antibiotic should be considered.

2. In the stable graft period. (after 3-6 months) Antibioitic should

be considered for

invasive proceedures.

3. In chronic graft rejection only emergency dental care should be

considered.

I'm not sure of the definition of invasive dental proceedures.

I'm not sure what they mean by " consider " but I think it means to

weight the pros and cons for an individual patient.

My apologies for the long link.

http://www.agd.org/library/2005/feb/Byron_151.pdf#search=%22Dental%20management%\

20of%20the%20(solid)%20organ%20transplant%20patient.%22

[Guest guest]

I've not had problems with antibiotics (not sure what a large dose is), but

I do recommend taking a probiotic if you're on antibiotics. We do this with

our horses every time they're placed on antibiotics. Loss of intestinal

flora/fauna in an equine is NOT a pleasant experience.

Antibiotics for dental work is frequently recommended for us - especially

those on immunosuppressives.

Arne

55 - UC 1977, PSC 2000

Alive and (mostly) well in Minnesota

________________________________

From: [mailto: ] On

Behalf Of pej_jones

I'm having my first dentist appointment since my transplant tomorrow

and the doctor has told me that I need to take a large dose of

antibiotics an hour before. I have a very sensitive stomach and I'm

concerned that such a high dose might make me sick. (No, fun)

Does anyone know why this is even needed? Has anyone had any problems

from taking such a high dose?

[Guest guest]

I've not had problems with antibiotics (not sure what a large dose is), but

I do recommend taking a probiotic if you're on antibiotics. We do this with

our horses every time they're placed on antibiotics. Loss of intestinal

flora/fauna in an equine is NOT a pleasant experience.

Antibiotics for dental work is frequently recommended for us - especially

those on immunosuppressives.

Arne

55 - UC 1977, PSC 2000

Alive and (mostly) well in Minnesota

________________________________

From: [mailto: ] On

Behalf Of pej_jones

I'm having my first dentist appointment since my transplant tomorrow

and the doctor has told me that I need to take a large dose of

antibiotics an hour before. I have a very sensitive stomach and I'm

concerned that such a high dose might make me sick. (No, fun)

Does anyone know why this is even needed? Has anyone had any problems

from taking such a high dose?

[Guest guest]

I've not had problems with antibiotics (not sure what a large dose is), but

I do recommend taking a probiotic if you're on antibiotics. We do this with

our horses every time they're placed on antibiotics. Loss of intestinal

flora/fauna in an equine is NOT a pleasant experience.

Antibiotics for dental work is frequently recommended for us - especially

those on immunosuppressives.

Arne

55 - UC 1977, PSC 2000

Alive and (mostly) well in Minnesota

________________________________

From: [mailto: ] On

Behalf Of pej_jones

I'm having my first dentist appointment since my transplant tomorrow

and the doctor has told me that I need to take a large dose of

antibiotics an hour before. I have a very sensitive stomach and I'm

concerned that such a high dose might make me sick. (No, fun)

Does anyone know why this is even needed? Has anyone had any problems

from taking such a high dose?

[Guest guest]

I've done this all of my life since I have a heart murmer. It can make

your stomach a little queasy - I eat mine with food. The hardest part

is getting the large pills down. If I remember my last time, it was

four capsules of ammoxicillan prior to the appointment and another

four pills afterwards for a total of eight pills...As far as

antibiotic doses go, sure it is a lot at once, but it isn't like

you're doing a " big gun " antibiotic...

HTH,

Deb in VA

PSC 1998, UC 1999, Listed Ltx 2001, LDLTX 5/19/2005

> Does anyone know why this is even needed? Has anyone had any

problems

> from taking such a high dose?

>

[Guest guest]

I've done this all of my life since I have a heart murmer. It can make

your stomach a little queasy - I eat mine with food. The hardest part

is getting the large pills down. If I remember my last time, it was

four capsules of ammoxicillan prior to the appointment and another

four pills afterwards for a total of eight pills...As far as

antibiotic doses go, sure it is a lot at once, but it isn't like

you're doing a " big gun " antibiotic...

HTH,

Deb in VA

PSC 1998, UC 1999, Listed Ltx 2001, LDLTX 5/19/2005

> Does anyone know why this is even needed? Has anyone had any

problems

> from taking such a high dose?

>

[Guest guest]

I've done this all of my life since I have a heart murmer. It can make

your stomach a little queasy - I eat mine with food. The hardest part

is getting the large pills down. If I remember my last time, it was

four capsules of ammoxicillan prior to the appointment and another

four pills afterwards for a total of eight pills...As far as

antibiotic doses go, sure it is a lot at once, but it isn't like

you're doing a " big gun " antibiotic...

HTH,

Deb in VA

PSC 1998, UC 1999, Listed Ltx 2001, LDLTX 5/19/2005

> Does anyone know why this is even needed? Has anyone had any

problems

> from taking such a high dose?

>

[Guest guest]

Today my daughter is getting married!! This has been such an amazing 18 months. We have gone from desparation and fear with the tx to the craziness of planning a wedding. I am singing in the wedding so that is my biggest fear. Once I am done than I can breathe. I am afraid I will either cry or really screwup. is in the wedding and looks amazing. When we get digital pixs I will post one to show you how terrific it can be post tx. MartiBarb Henshaw wrote: -----Original Message-----I'm sorry I'm not up on all the abbreviations. What does ESLD stand for? End Stage Liver Disease. The doctor that said Ken should take antibiotics before going to the dentist was his GI. Barb in Texas - Together

in the Fight, Whatever it Takes! Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas _

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