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I'm due to have a tooth extracrion & find there is still some disagreement over whether antibiotic cover is still required. Does anyone have recent experience of this? I'm three years since my avr.

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Dear Chris,

The advice in Europe is to take 2mg Amoxicilline 2 hours prior to a visit to the dentist. However in the USA & UK the advice is a bit fuzzy - some say take it outhers say don't. Take it, it will do no harm.

  • For infective endocarditis prophylaxis, 2007 guidelines by the American Heart Association, written with input from the ADA and approved by the CSA as they relate to dentistry in 2008, support premedication for a smaller group of patients than previous versions. This change was based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous versions of the guidelines. Concern about the development of drug-resistant bacteria also was a factor.

  • Infective endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis (see “Patient Selection,” in the main text). For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.

Many thanks. Sad there seems to be no definitive answer. I wonder why?
Just in case anyone else is interested my cardiologist has said I need antibiotic cover even though my dentist & GP say it's not needed.

Yes this is the way to go, can't harm - only protect. Good luck Kevin Parvin

chris gidney said:

Just in case anyone else is interested my cardiologist has said I need antibiotic cover even though my dentist & GP say it's not needed.

My dentist does not think this is necessary, and my cardiologist sort of agreed.  Personally I try and avoid antibiotics as it sends my INR haywire.  I only take them when it is really necessary.  I haven't had an extraction since my hard valve replacement, so I have not had to make a decision of this nature.

I have to admit, I think I would take a safety first approach and take it! 

A bit of a delayed post as I have not been on the site for a while now, but I have suffered the difference of opinions on this topic.  My specialist has recommended antibiotic cover for any intrusive dental treatment (includes seeing the hygienist as they can introduce bacteria when cleaning round the gum line) and my dentist agrees with them - most likely because his father has a MHV so understands the situation better than most.  It has been my GP that has not wanted to prescribe the antibiotics. The only way I resolved it was to get my dentist and the GP to talk to each other. After one phone call the GP sent me the prescription.  Luckily antibiotics have never affected my INR's so there is no down side in taking them for dental work.

It is better to err on the side of caution - if the specialist says you need it then that is the way to go.

Spot on John! Hope you are well and that life is cool. I am now retired, well have been on a preretirement (Frenh) deal for three years, I just love it.



Hi Kevin - glad all is OK with you and retirement is treating you well...

I have just escaped to the country myself - my wife and i have given up the jobs and moved to the New Forest. Life is too short so you have to enjoy it !

Thanks guys. I went to the 'top' eventually and my surgeon replied that there should be antibiotic cover without exception. Enjoy that country life!
Glad you got it sorted. I have just had to register with a new GP and dentist following the move but not broached this topic with them yet. So I am sure I will go through the same discussion again. I will refer them to my discharge notes, from 5 years ago, where the surgeon clearly states antibiotic cover is required for dental treatment.

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