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  • New dental guidelines

    I am not sure if this has been discussed yet. Sorry if this is a duplicate.
    How does this relate to those with HCM?

    Guidelines: Only Some Need Dental Antibiotics
    Risks May Outweigh Benefits

    POSTED: 9:46 am EDT April 20, 2007

    Taking antibiotics before visiting the dentist may do more harm than good, the American Heart Association says.

    Some dentists prescribe antibiotics before routine cleanings or extractions to prevent infective endocarditis, an infection of the heart's inner lining or valves. But the AHA now says that is only needed for people at high risk, such as those with artificial valves, a history of endocarditis or serious heart problems.

    The doctor who led the work, Walter Wilson, said there is no evidence that the antibiotics prevent infection, and they may increase resistance of bacteria when infections do occur.

    A news release said that everyday tooth brushing causes 154,000 times the risk of exposure to bacteria that could cause problems than having a tooth pulled.

  • #2
    Re: New dental guidelines

    I don't know about this, but when my son had his myectomy last month, we were instructed by the staff at the Mayo to have him take antibiotics before any dental procedures. I don't know if they (Mayo staff) routinely tell all HCM patients to take antibiotics or take it case by case according to risk level. I'd be curious what counsel others have been given about this issue.


    Gwen
    13-year-old (adopted) son diagnosed August 2006, septal myectomy March 29, 2007, Mayo Clinic-Rochester, MN, ICD implantation, May 20, 2009, Monroe Carell Jr. Children’s Hospital at Vanderbilt (Vanderbilt University Hospital), Nashville, TN
    One thing this diagnosis has done for me is to not take his life for granted, but to appreciate each day that I have with him, to enjoy his wonderful sense of humor and cherish his sweet smile.

    Comment


    • #3
      Re: New dental guidelines

      I have to say that I read these also with some disbelief. I was also told when I was at Mayo last summer to premedicate, and they made quite a big deal about it, so I am not sure that I will adhere to these new guidelines until I hear it from the mouth of my HCM doc.
      Daughter of Father with HCM
      Diagnosed with HCM 1999.
      Full term pregnancy - Son born 11/01
      ICD implanted 2/03; generator replaced 2/2005 and 2/2012
      Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

      Comment


      • #4
        Re: New dental guidelines

        Please continue your premedication program as directed by your doctors (for the past 40 years!). Many HCM specialists are very concerned over this report and they are currently evaluating how they are going to respond.

        Endocarditis is real, many of our members have had it already and several can point to a dental procedure or medical procedure as the point of contact - myself included.

        Please continue to follow the instructions given to you in the past.

        Lisa
        Knowledge is power ... Stay informed!
        YOU can make a difference - all you have to do is try!

        Dx age 12 current age 46 and counting!
        lost: 5 family members to HCM (SCD, Stroke, CHF)
        Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
        Therapy - ICD (implanted 97, 01, 04 and 11, medication
        Currently not obstructed
        Complications - unnecessary pacemaker and stroke (unrelated to each other)

        Comment


        • #5
          Re: New dental guidelines

          I visit the dentist twice a year and take my premeds each time.
          I cannot see how taking the premeds only twice a year will build up a resistance to infections.
          There are people who take antibiotics far more regular than twice a year, like everytime they think they are coming down with something. They are the people who should be worried.
          I'm seeing Dr. Wigle next week for my annual, I'll ask him what he thinks.
          Every great thing that has ever happened since the beginning of time has started as a single thought in someones mind.
          So if you are capable of thought then you are capable of great things
          Good luck and stay well.
          Glen

          Comment


          • #6
            Re: New dental guidelines

            Heck, I can't even get my dentist to follow the 'old' guidelines. Thankfully, my PCP writes me an annual prescription for amoxicillin, enough to cover several visits to the dentist, and I just pre-medicate myself. Just another incidence of us having to look after ourselves, because sometimes we're the only ones who are.
            "Some days you're the dog... some days you're the hydrant."

            Comment


            • #7
              Re: New dental guidelines

              I was just at the dentist Saturday for a cleaning and he requires me to premedicate. In fact, he always asks before he lets me sit in the chair. Fortunately, he seems to believe HCM is a serious heart disease. He also gives me a year's prescription of amoxicillin since my previous EP refused to give me a script saying it was the dentist's responsibility. Well, that is why I dumped that EP a few years ago.

              Be well, Janet
              Believe in the goodness of mankind.

              Comment


              • #8
                Re: New dental guidelines

                Originally posted by Glen Beamish View Post
                I visit the dentist twice a year and take my premeds each time.
                I cannot see how taking the premeds only twice a year will build up a resistance to infections.
                There are people who take antibiotics far more regular than twice a year, like everytime they think they are coming down with something. They are the people who should be worried.
                I'm seeing Dr. Wigle next week for my annual, I'll ask him what he thinks.
                Glen:

                I'm sure Dr. Wigle will tell you you need an antibiotic. My husband is also a patient of Dr. Wigle's and we were told last week that my husband needs an antibiotic before any invasive procedure. He had a colonoscopy earlier this month and of course he had to have antibotics before that as well.

                Comment


                • #9
                  Re: New dental guidelines

                  Better safe than sorry!!

                  Comment


                  • #10
                    Re: New dental guidelines

                    [QUOTE= serious heart problems.[/QUOTE]

                    Um, that would be HCM! Duh. We all know the AHA doesn't know beans about HCM anyway. I'm sure they lump HCM, DCM, etc, etc, into that phrase and figure that doctors and patients will just know what they mean.

                    Over-prescribing of antibiotics IS a big problem, but I think their new guidelines is intended to reach the millions of people with benign murmurs who may not need them for a cleaning--not HCMers.

                    Comment


                    • #11
                      Re: New dental guidelines

                      I agree with you Sarah.

                      It is interesting that the AHA specifically mentions HCM among those conditions no longer requiring prophylaxis:

                      The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

                      - mitral valve prolapse
                      - rheumatic heart disease
                      - bicuspid valve disease
                      - calcified aortic stenosis
                      - congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

                      “These patients still have a lifelong risk of IE,” Wilson said. “We’re just saying that the risk is much greater from a random blood-borne bacterial infection resulting from everyday activities than from a dental or medical procedure.”


                      Full Text

                      Jim
                      Last edited by mtlieb; 04-26-2007, 02:25 AM.
                      "Some days you're the dog... some days you're the hydrant."

                      Comment


                      • #12
                        Re: New dental guidelines

                        Your right Goldie, Dr. Wigle has always told me to take premeds and I don't expect that to change.
                        Every great thing that has ever happened since the beginning of time has started as a single thought in someones mind.
                        So if you are capable of thought then you are capable of great things
                        Good luck and stay well.
                        Glen

                        Comment


                        • #13
                          Re: New dental guidelines

                          Well, I trust the HCM specialists at the Mayo, so I will follow their advice. Just like Cynthia, they were pretty adamant to me about having our son premedicated, so until I hear differently from them, I'll make sure that he's premedicated!
                          13-year-old (adopted) son diagnosed August 2006, septal myectomy March 29, 2007, Mayo Clinic-Rochester, MN, ICD implantation, May 20, 2009, Monroe Carell Jr. Children’s Hospital at Vanderbilt (Vanderbilt University Hospital), Nashville, TN
                          One thing this diagnosis has done for me is to not take his life for granted, but to appreciate each day that I have with him, to enjoy his wonderful sense of humor and cherish his sweet smile.

                          Comment


                          • #14
                            Re: New dental guidelines

                            How are they calculating that risk? That is what I find so interesting. The odds of getting a random blood infection are actually extremely low as long as you aren't immune-suppressed, but if you are going to the dentist and having the bacteria essentially drilled into you, isn't that a higher risk?

                            Comment


                            • #15
                              Re: New dental guidelines

                              There may be a difference in the risks for people with non-obstructive HCM and those with the obstructive version.

                              I'd guess that a diagnosis of "HCM" alone isn't necessarily a reason to be taking antibiotics. It all depends on the exact functioning of the heart - whether there is an obstruction, the turbulence of the blood flow, whether there is mitral regurgitation, etc.

                              Any dentist who is unsure should get an opinion from a cardiologist.

                              Comment

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