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Antibiotics and dental work


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My new cardiologist wants me to take antibiotics for dental work because I have mild aeortic regurgitation. The question is how mild is it. Past cadiologists have never suggested antibiotics but then this guy is more on the ball.

They want me to take 2000mg of Keflax at once before a procedure, especially before a cleaning. I'm so med sensitive and don't do well on meds so I'm really afraid that'll be a toxic dose for me. I actually thought they had made a mistake when they told me how much to take. And it sounds like it's not negotiable.

It's what the American Heart Association recommnends but they don't take in account a persons weight and height. And metabolism. I'm really small and I tend to need less meds to do the trick.

Anyone else have to take antibiotics before dental work and if so how have you handled such a huge dose at once.?

Last time I took Ceftin I started feeling really weird on it afer the 3rd day On a normal dose. Ceftin is a cousin to Keflax. Both are really the only antibiotics I'm not allergic to.

Thanks,

GayleP

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Gayle, as I understand it, there's literally a one in a million chance of (heart) infection as a result of dental work -- but neither you nor your dentist want to be that one! I emailed a friend with a heart murmur who I knew took antibiotics before dental work, and he wrote, "I take 4 500 mg capsules of amoxicillin an hour before. They used to recommend a lot more, but the dosage has gone down in recent years." So there's your 2000 mg; different drug. This friend's dentist is the one who prescribes the meds--not a cardiologist. You might call your dentist to see what dose s/he recommends--and whether or not s/he feels it's absolutely necessary, given your reaction to antibiotics. (I would suggest a second opinion from a different cardiologist, but it sounds like you already have that... Want to call back one of your former docs and ask?)

hope this helps some ...

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I used to take the 4 500 mg amoxicillin capsules when my first doctor THOUGHT I had mitral valve prolapse. Later I had an echo and it showed very minimal mild mitral regurgitation, and a different cardiologist said I did not need antibiotics. We will see what this even newer cardiologist says this week; I had an echo today, and I am willing to bet I will be put back on antibiotics for dental work. It's maddening.

Are you allergic to penicillin? I would think amoxicillin would be the most mild antibiotic. I wonder why he chose Keflex. Did you express your concern? How about asking to try taking two some time when you don't have dental work, just to see how you process them? I know it's never good to take antibiotics unnecessarily, but if you're trying to test for toxicity, that may be a good method. I really don't know what else you can do except see what happens.

Amy

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Merrill,

Thanks for the statistics. I didn't realize the risk heart infection was that rare with dental work.

Wow, your friend takes a huge amount of Amoxicillan. That was my cardio's initial drug of choice but I'm allergic to it. It's hard to believe that the heart association used to recommend even higher doses.

Your suggestion of getting a second opiniom makes sense. Either that or sit down with my cardiologist to see if it's really necessary given my weird reaction to meds. My past cardiologists, all part of my HMO have either quit or I fired them. I did have a really good cardio consut at Mayo a few years ago so I might try to contact them. Unfortunately my dentist doesn't really have an opinion one way or another so he is of no help.

I have gone all these years never taking an antibiotic for dental work and it was never an issue until my nephew died of a heart infection several years ago. His infection was not related to dental work and in fact I don't think they ever knew how it happened. But it brings the idea of an infection closer to home.

Thanks again,

GayleP

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Amy,

I post so slowly that I didn't see your post when I answered Merrill.

Yes, I am really allergic to Penicillin. Keflex was their third choice because I was also allergic to their second. I spoke to my cadiologist's nurse and did express my concern but she didn't understand what I ment by the words "med sensitive" and "feeling weird" from meds. She only understands allergy to meds or no allergy. I'm hoping my cardiologist will get what I mean. He doesn't do phone calls so I have to go back and see him.

I supppose I could try to take 4 Keflex at once at home to see how I do. I did tell my husband that he would have to take me to the cleaning if I have to take the anibiotics because I don't trust driving in case I feel strange afterwards.

Hope your echo was OK. And good luck with your new cardiologist appointment.

GayleP

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Gayle, I guess I'd suggest going the route of securing as much information as you can from your doctors, past or present. And then go the safest route. I mean--if you can arrange to have your dental appointment before a weekend or if you can time it so that you have space to lay low for a bit--I'd go ahead and take the antibiotics. Having someone accompany you to your appointment is always a nice idea--and so much more fun for you anyway! :) (I wouldn't try the antibiotics at home first tho--overtaking antibiotics is the chief reason why there are so many resistant strains of nasty bugs out there, and you really don't want to be contributing to that--especially since you are so limited in the kinds of antibiotics you can take in the first place!)

All that's to say, I'd opt for feeling weird for a bit as a result of the drugs over battling a potentially fatal heart infection any day. .. if that is indeed a real risk! (and that's what you need to find out for sure ... but if you can't find out, then take the drugs and try not to worry too much. Easier said than done, I know! Sorry... :) )

Don't forget about the carbocaine 3% if you need to get numb!

Take care,

Merrill

PS I should add that my dentist refused to do any work on me when I saw him in-between the heart tests I was having earlier this year, when I was first in the process of being diagnosed with POTS. He said we needed to be sure it wasn't indicated--he didn't want to be that one in a million either! Be safe!

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Dear Gayle.

My mother is in the same boat as you. However, she takes her dose over the 3 days before the dentist visit. I can also understand why he went for Keflex, it is an older, well tolerated drug. It also happens to be one of four I know I can take. Ask if you can start the day, or even two days, before the procedure with half, or 1/4 the dose to check for a reaction. That way if you do have trouble, you won't be in the middle of a dental visit and having to end up in the ER. (been there, it really *****)

Best of luck, Blackwolf

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Hi,

I have been taking anti-biotics since I was 11 before going to the dentist. I have always taken Keflex and it never bother me not even at that high dose. I am like all of you very very sensitive to antibiotics in general but I tolerate the Keflex very well. It is rare that you will get a heart infection from the dentist but why take the chance is my thought. We have enough to deal with. Besides a little yucky burbing I really have not had a problem with Keflex at all. Just for a note Doxycycline is also one I can take with out trouble. Talk to your dentist but the 2000 is a normal dosage.

I just took some Monday before the dentist and it was ok. The dentist was horrible but the anti-biotics were ok!:angry:

Stacey :-)

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Blackwolf,

Thanks for the info on your mom. I had also thought about taking the Keflex the day before, breaking up the dosage but was told that it wouldn't be an option because my blood level would not be high enough. I still need to talk to my cardiologist and see if tha's an option. He might think it makes sense.

Stacey,

Thanks for sharing your experience. If I absolutely have to take it ,it's good to know that someone else handled that much Keflex. I agree, better safe than sorry. I think the issue for me now is not whether to take it but if I can break up the dose.

Merril

I finally got my dentist to agree on Carbocaine(sp). He hates uisng it but agreed to or I won't go to him anymore.

One last thing. From what I undestand antibiotics atre only needed for cleaning and things like root canals and gum surgery. You might not neeed them with fillings and crowns. Is that correct?

Thanks again,

GayleP

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Gayle--now you've got me curious--what's he got against carbocaine? Did he tell you? The only thing I can definitely say is that it's not as long-lasting as other things (like regular novacaine) ... It may begin to wear off during your appointment, depending on how long you're in the chair and what you're having done. But if you feel ANYTHING, just ask the dentist to stop and give you some more! No big deal! You should always be comfortable...no reason not to be.

On the question of whether or not antibiotics would be indicated (again, for someone with a known heart condition--prolapse, murmur, etc) for a crown or filling--I would say yes, a person should take the meds in advance. Here's why: the dentist can't possibly be 100% sure--even with x-rays--how deep the decay goes. There are often surprises in dentistry, and the decay can be at or below the gum line. If there's any blood at all (which is why if you're not scrupulous about your oral hygiene there can be blood during a routine cleaning), then you'd want to be on the antibiotic--IF it's warranted because of a heart condition. (I'm emphasizing this because I'd hate for people to start hittin' the ol' panic button and asking for unnecessary antibiotics etc.)

that's my take, anyway!

best,

merrill

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Merrill,

I think my dentist doesn't like using Carbocaine because it doesn't last that long and according to him there is a limit on how much he can use.

But I get numb very fast and stay numb for hours so it's not a problem. He used it on me for a crown a while back ( I don't think he remembers) and I stayed numb the whole time. I didn't even need a second injection.

Thanks ,

Gayle

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My dentist used to have me take antibiotics before procedures as well. I thought 2000mg was a mistake too. I even called the pharmacy to double check that they'd gotten it right. Like you, I am small and so I was concerned about it. However, I took the dose multiple times through the years and never had any problem with it.

Michelle

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Michelle,

Thanks for sharing your experience. It helps to know other people have tolerated such a big dose.

Also from what I understand Keflex has a short half life, shorter than Ceftin. Still, just to be safe I'll have my husband take me to the cleaning the first time I have to take it.

GayleP

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